This week a new recommendation came out that people at high risk for lung cancer - particularly current or previous heavy smokers - should be screened for lung cancer with CT scans. This is another way that cancer can be detected at an earlier more treatable stage.
'Great,' we say. On the surface this seems like a good idea - catch a cancer early on and save more lives. Advanced testing options which have become relatively more accessible and affordable over the years have opened up testing options for millions.
But, and there is a big fat BUT here, does the additional screening add false positives which equal expense and stress for the patient? This is the same argument for women who have had breast cancer that they all should have MRIs in addition to mammograms each year to screen for recurrence.
All this wonderful new testing does great things. They find things that are something 'bad' and catch it early. They also find things that are big enough to see but too small to do anything about. And where does that leave the patient?
Medical advances are great but sometimes the advances exceed the capabilities that are required to diagnose and treat the findings.
This does not even touch on the issue of over testing and the emotional toll. Whether a positive or negative result, the testing experience is an emotional roller coaster ride for the patients. False positives and false negatives are realities in the results. Non test is 100% fallible so these do take place.
Me, personally, I am a big fan of the lets waiting and watching at this point. Unless I have symptoms I am not bounding off to see the doctor. I don't want more tests. I am happy this way.
Showing posts with label medical tests. Show all posts
Showing posts with label medical tests. Show all posts
A simple test
Right now the only way for a doctor to diagnose fibromyalgia in a patient is to press on a bunch of tender points. If more than so many of them are sore, the diagnosis is fibromyalgia. How easy. Not.
First of all when a patient shows up complaining of pain, other tests are done to rule out all sorts of other conditions. This can take time. As in months or years even.
It takes three to five years for a patient to be diagnosed with fibromyalgia. That is a really long time to live in pain. And often fibromyalgia is diagnosed with other conditions.
I was told I have fibro and have rheumatoid. We are trying to get the RA under control so we can then focus on treating the fibro pain. I was also told that it is often impossible to distinguish pain caused by RA vs. the pain caused by fibro.
I am in the state of still trying to get the RA under control so we can talk fibro pain.
But now there is good news. There is a new diagnostic test to diagnose fibromyalgia. It is supposed to be 99% accurate. The problem is that it costs $744 and most insurance companies do not cover it. [That needs to change.]
And even more good news there are two more tests being developed that look at blood markers to diagnose fibro. These are still in development but represent lots of progress.
I will talk to my doctors about the new test and to my insurance company. Because the diagnosis criteria are relatively vague, in my mind, I think I would prefer a solid yes/no test. And if it could reduce the three to five year time frame to diagnose fibro for others, even better.
First of all when a patient shows up complaining of pain, other tests are done to rule out all sorts of other conditions. This can take time. As in months or years even.
It takes three to five years for a patient to be diagnosed with fibromyalgia. That is a really long time to live in pain. And often fibromyalgia is diagnosed with other conditions.
I was told I have fibro and have rheumatoid. We are trying to get the RA under control so we can then focus on treating the fibro pain. I was also told that it is often impossible to distinguish pain caused by RA vs. the pain caused by fibro.
I am in the state of still trying to get the RA under control so we can talk fibro pain.
But now there is good news. There is a new diagnostic test to diagnose fibromyalgia. It is supposed to be 99% accurate. The problem is that it costs $744 and most insurance companies do not cover it. [That needs to change.]
And even more good news there are two more tests being developed that look at blood markers to diagnose fibro. These are still in development but represent lots of progress.
I will talk to my doctors about the new test and to my insurance company. Because the diagnosis criteria are relatively vague, in my mind, I think I would prefer a solid yes/no test. And if it could reduce the three to five year time frame to diagnose fibro for others, even better.
Basic screening tests take on a new meaning after cancer
Most people, by this I mean people who have never had cancer, go to the doctor for check ups and get sent for tests and don't think twice. They get nice negative results sent to them in the mail and they don't think twice about it.
Throw in a few cancer diagnoses, and any screening test takes an ominous turn. Of course any screening test will show that you are doomed. There is no way you will ever get a clean result again. One test will lead to another which will lead to another which will lead to another and then surgery, chemo, and more and more and more.
Or so the little voices in your head tell you.
It is perfectly acceptable to have little voices in your head after cancer.
Its when they take over all rational thought that you really are screwed. This is why we have psychiatrists, psychologists, and anti-depressants to keep us sane.
However our screening tests still can drive us crazy.
Throw in a few cancer diagnoses, and any screening test takes an ominous turn. Of course any screening test will show that you are doomed. There is no way you will ever get a clean result again. One test will lead to another which will lead to another which will lead to another and then surgery, chemo, and more and more and more.
Or so the little voices in your head tell you.
It is perfectly acceptable to have little voices in your head after cancer.
Its when they take over all rational thought that you really are screwed. This is why we have psychiatrists, psychologists, and anti-depressants to keep us sane.
However our screening tests still can drive us crazy.
Some clarification here
I got some feedback yesterday that my blog about the patient who didn't get a needed scan in time now has weeks to live. I said the patient needed to do more and be proactive in their health care. Some one said that we can't blame the patient because we depend on our doctors.
What I see of the issues are the following:
The woman complained of severe headaches and pain down her arm. Her doctor told her it was arthritis and treated it as such. She also complained several other times to nurses and was told she didn't need scans. If the diagnosis didn't resolve the problem, more testing should have been done to get to the root of the problem. This is where the patient could have stepped up.
Also it sounded like she was dealing with nurses often - did they know the extent of her medical history?
And if this doctor wasn't doing anything to help her, she could have gone to another doctor which it did not sound like she did. I mean she did say she had bowel surgery which meant she was going to a gastrointestinal doctor, who wouldn't have been as concerned about something not relating to digestion. What about a neurologist or some one like that?
I don't know all the details here because I am not that patient but it would seem to me in the modern medical world that this patient slipped through the cracks and her complaints were ignored. This is where the patient should have spoken up more.
Yes we depend on our doctors to tell us what is wrong with us and treat us. We depend on them and rely on them. Some times we put our head down and just slog on through things. But need to stick our head up occasionally and see if we are happy with how we are feeling or is ti time to take another tack.
What I see of the issues are the following:
The woman complained of severe headaches and pain down her arm. Her doctor told her it was arthritis and treated it as such. She also complained several other times to nurses and was told she didn't need scans. If the diagnosis didn't resolve the problem, more testing should have been done to get to the root of the problem. This is where the patient could have stepped up.
Also it sounded like she was dealing with nurses often - did they know the extent of her medical history?
And if this doctor wasn't doing anything to help her, she could have gone to another doctor which it did not sound like she did. I mean she did say she had bowel surgery which meant she was going to a gastrointestinal doctor, who wouldn't have been as concerned about something not relating to digestion. What about a neurologist or some one like that?
I don't know all the details here because I am not that patient but it would seem to me in the modern medical world that this patient slipped through the cracks and her complaints were ignored. This is where the patient should have spoken up more.
Yes we depend on our doctors to tell us what is wrong with us and treat us. We depend on them and rely on them. Some times we put our head down and just slog on through things. But need to stick our head up occasionally and see if we are happy with how we are feeling or is ti time to take another tack.
False positive test results
One of the complaints about annual mammograms is the possibility of false positive results. They can cause emotional trauma years later.
Any false positive test result can be very scary. I am very sympathetic to this. No one wants to be told they have something 'bad' and to be told that they have something 'bad' and then be told that they were wrong, would be worse. But from my point of view (with my medical history) I can say having something 'bad' is infinitely worse than not having something 'bad'.
To understand my point of view, look at my medical history.
In 1981, I was told I probably had a goiter on my thyroid or something but they needed to operate to be sure because this was the time before biopsies. A goiter could cause problems in the long run so they went to take it out. Surprise, surprise, not a goiter but a tumor, and a malignant one to boot into lymph nodes as well.
Then in 1984, I had a breast lump. As I was already in the class of 'with your medical history, we need to be sure' and it was before breast biopsies, I had to have it out. I was happy to be told it was not cancer but a benign tumor. But I did get to stress through it.
Repeat regularly through the next 20+ years of 'with your medical history, we need to be sure'. I have had uterine fibroids that were 'sliced and diced' (to use my surgeon's words) to check for cancer after removal. I had that nasty mammogram in 2007 which led to all sorts of medical adventures. Then after chemo I had another tumor - how did that happen? (I am probably the only person on record to grow a tumor during chemotheraphy.) But it was benign. After a great deal of stress on my part.
I would not want to have a false positive mammogram or any test at this point but isn't it better to test and have the occasional false positive than to have people not be diagnosed until too late?
Any false positive test result can be very scary. I am very sympathetic to this. No one wants to be told they have something 'bad' and to be told that they have something 'bad' and then be told that they were wrong, would be worse. But from my point of view (with my medical history) I can say having something 'bad' is infinitely worse than not having something 'bad'.
To understand my point of view, look at my medical history.
In 1981, I was told I probably had a goiter on my thyroid or something but they needed to operate to be sure because this was the time before biopsies. A goiter could cause problems in the long run so they went to take it out. Surprise, surprise, not a goiter but a tumor, and a malignant one to boot into lymph nodes as well.
Then in 1984, I had a breast lump. As I was already in the class of 'with your medical history, we need to be sure' and it was before breast biopsies, I had to have it out. I was happy to be told it was not cancer but a benign tumor. But I did get to stress through it.
Repeat regularly through the next 20+ years of 'with your medical history, we need to be sure'. I have had uterine fibroids that were 'sliced and diced' (to use my surgeon's words) to check for cancer after removal. I had that nasty mammogram in 2007 which led to all sorts of medical adventures. Then after chemo I had another tumor - how did that happen? (I am probably the only person on record to grow a tumor during chemotheraphy.) But it was benign. After a great deal of stress on my part.
I would not want to have a false positive mammogram or any test at this point but isn't it better to test and have the occasional false positive than to have people not be diagnosed until too late?
Too many screening tools
Now the big 'hoo haw' in the medical world is preventative care. You know they want people to have annual physicals and get certain screening tests - mammograms, PSA, and colonoscopies. I personally think a bit of prevention goes a long way.
But we can't focus on that and test everyone to death (bad choice of words there?) can we? I mean its bad enough that I go to my PCP for a physical and I get sent for blood tests. I used to get annual chest x-rays because I have had a thingy in my lungs but after thirty years of annual commemorative pictures, they have changed protocols and said I no longer need those.
I also still get annual visits with the radiation oncologist and breast surgeon, three times a year with the medical oncologist, twice a year with the endocrinologist and four times a year with someone in rheumatology which is more than the average bear. Because with my medical history, they need to be sure but I am not so sure about the rest of the population. How many tests do they need? I question this.
Last year medical organizations came out about tests we generally do not need. I blogged about these somewhere in my blog but can't find them... I have to get to work, I don't have hours to dig through my blog so trust me it is there.
Now medical research is busy adding new screening tests. Some British researchers have found a link between lifestyle and developing rheumatoid arthritis. They found:
Their recommendation, as a result, is to develop a screening tool to identify patients with a higher risk and who could be given advice on how to reduce their risk. (I'm not signed up for any special social class so how would I know if I am at a lower risk?) Not helpful.
So let me review this. The movement these days is to reduce unnecessary tests and research is creating more tests. Sounds like a vast conspiracy to me.
But we can't focus on that and test everyone to death (bad choice of words there?) can we? I mean its bad enough that I go to my PCP for a physical and I get sent for blood tests. I used to get annual chest x-rays because I have had a thingy in my lungs but after thirty years of annual commemorative pictures, they have changed protocols and said I no longer need those.
I also still get annual visits with the radiation oncologist and breast surgeon, three times a year with the medical oncologist, twice a year with the endocrinologist and four times a year with someone in rheumatology which is more than the average bear. Because with my medical history, they need to be sure but I am not so sure about the rest of the population. How many tests do they need? I question this.
Last year medical organizations came out about tests we generally do not need. I blogged about these somewhere in my blog but can't find them... I have to get to work, I don't have hours to dig through my blog so trust me it is there.
Now medical research is busy adding new screening tests. Some British researchers have found a link between lifestyle and developing rheumatoid arthritis. They found:
they found that smoking, obesity and having diabetes all increased the risk. It was also found that drinking a small amount of alcohol and being in a higher social class were associated with a reduced risk of developing the disease.
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
"... they found that smoking, obesity and having diabetes, all increased the risk. It was also found that drinking a small amount of alcohol and being in a higher social class were associated with a reduced risk of developing the disease."Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
Their recommendation, as a result, is to develop a screening tool to identify patients with a higher risk and who could be given advice on how to reduce their risk. (I'm not signed up for any special social class so how would I know if I am at a lower risk?) Not helpful.
So let me review this. The movement these days is to reduce unnecessary tests and research is creating more tests. Sounds like a vast conspiracy to me.
they found that smoking, obesity and having diabetes all increased the risk. It was also found that drinking a small amount of alcohol and being in a higher social class were associated with a reduced risk of developing the disease.
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
they found that smoking, obesity and having diabetes all increased the risk. It was also found that drinking a small amount of alcohol and being in a higher social class were associated with a reduced risk of developing the disease.
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
they found that smoking, obesity and having diabetes all increased the risk. It was also found that drinking a small amount of alcohol and being in a higher social class were associated with a reduced risk of developing the disease.
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
Read more at: http://medicalxpress.com/news/2013-03-links-lifestyle-rheumatoid-arthritis.html#jCp
From avoidance to cranky
So how did this happen. I was in avoidance mode because of my doctor appointment which went fine) as fine can be with an hour of unexplained wait due to rude nursing staff who preferred talking about their boy friends, cell phones, caller ID, and the weather forecast). I ended up with blood tests in six months and blood tests, ultrasound, and follow up in one year. That's just fine.
Then I had to go to a meeting which started early to accommodate someone's understandable scheduling request but was full of unorganized and critical people who were happy to nitpick and and express opinions but not volunteering for much work at all. I heard a couple of times 'are we done yet'? I may need to remove myself from the committee. Not over the nitpicking - we want to do things right but because of the lack of help they are providing. But I was already crabby so who am I to complain?
Next we have a tiny snow storm forecast for tomorrow and well into Saturday which will spoil all my Saturday socializing plans that I was looking forward to. Yesterday morning we were in the 3=6" range, by lunch time the double digit predictions were appearing and growing. And I can't really shovel snow or go out in play in it much - I might break out the snow shoes (unless my husband hid them on me) if we really get the predicted two feet of snow.
This morning I have to go to work after a meeting last night - which means I didn't get enough rest. And it doesn't help that after work I have to go to another work related networking event. I can come home after work and rest for a bit but it still means going out another night in a row - can you say extra crabby?
On top of all this, we are having windows replaced in the house. The plan was to be done by the end of the day tomorrow. They had a slow start but have been making great progress. Our current agreement is that we will talk this afternoon and see if they can finish before the storm (doubtful) and when they can return and finish which means rescheduling the carpet cleaning and the cleaning lady and the room painting. Our house is in chaos as three of the six rooms have been construction zones for ten days already.
Finally tomorrow, unless it is blizzarding by 8am, I will go to the gym and then go whine at my therapist and be home by noon, ready to be snow bound for 24 hours. Maybe I can take naps and get caught up on my sleep and required rest. But I have work to do after last night's meeting.
Avoidance mode
Today I am in avoidance mode. I have one of 'those' appointments today. I don't feel like talking about it, I'm a tiny bit stressed so I am going to the gym. Depending on the result, I may talk more about it later.
I'm also avoiding thinking about the stupid snowstorm on Friday might ruin my social life on Saturday. Grr.
Nope, rule changing is not allowed
I'm sorry but rule changing is not allowed. We have been good patients and gone for yearly checkups and now they want to change the rules. This is not allowed. I will not allow it. I have been good and now they want ot change the rules and say I have been bad. Not acceptable.
A Danish study recently concluded that regular health checkups may not be doing any good and may in fact be doing harm. The claim is that regular checkups do not decrease deaths from cancer or heart disease and also cause more testing, false positive and negative tests, and emotional and financial stress for the patients.
Hmmm.... Well I'm not agreeing with that one anytime soon. My cancers were both found by medical professionals or tests so I'm glad I had regular check ups.
"The authors conclude that more research is needed to target better methods for identifying disease and to further explore the possible misleading and harmful effects of general health check-ups."
So what this is really telling me is that its not the health checkups that are the problem is that research is needed to come up with better ways to diagnose ailments. So all the researchers did is guarantee themselves their jobs. I'm still going to my regular check ups. No rule changing allowed with out basis.
A Danish study recently concluded that regular health checkups may not be doing any good and may in fact be doing harm. The claim is that regular checkups do not decrease deaths from cancer or heart disease and also cause more testing, false positive and negative tests, and emotional and financial stress for the patients.
Hmmm.... Well I'm not agreeing with that one anytime soon. My cancers were both found by medical professionals or tests so I'm glad I had regular check ups.
"The authors conclude that more research is needed to target better methods for identifying disease and to further explore the possible misleading and harmful effects of general health check-ups."
So what this is really telling me is that its not the health checkups that are the problem is that research is needed to come up with better ways to diagnose ailments. So all the researchers did is guarantee themselves their jobs. I'm still going to my regular check ups. No rule changing allowed with out basis.
Subscribe to:
Posts (Atom)
