Skip to content

To Scan Or Not To Scan

July 29, 2010

For those of you not playing along at home, I have a badly broken neck. (Because, you know, there is such thing as a goodly broken neck?) The tip of my C2 vertebrae snapped off and is floating a scant few millimeters from my brain stem. As part of the same injury, my spinal cord tore a bit, and in an attempt to heal itself, formed a synovial cyst, which is also a few millimeters from – and putting pressure on – my brain stem. Because of the location of this mess, surgery is not an option. But, for obvious reasons, we’re trying to heal it, and it would be nice to know if the chip has moved, or the cyst has changed. Either of which, if in the “wrong” direction, could kill me instantly. In the “right direction” would be miraculous and awesome. However, the CT Scans to find out will very likely give me thyroid cancer.

If you saw me walking down the street today, you’d think I looked just fine. And I am. I am in pain, constantly, but you can’t see that and, frankly, I’m not letting it slow me down much. I mostly forget about it and live my life about how I’d like to. Except that I can’t do a lot of the things that I love most – anything that involves “jostling” or “bouncing” or “neck turning” or “pounding.” So, running, biking, swimming, skiing, rough sex, roller coasters. (Most of those I can do without, but not happily.)

In order to mitigate risk, I wear a neck brace most of the time. The hope is that by lengthening and supporting my neck, the cyst will drain and the bone chip will get safely entombed in scar tissue so that I will not be at risk any more. There’s no reason to believe it will or won’t work. There’s also no way to find out without CT Scans.

But there is increasing evidence that radiation in general, and aimed at the neck in specific, is causing increased thyroid cancer. One CT Scan is the rough equivalent of 1,100 x-rays. A quick perusal of available literature shows a pretty clear trend indicating that external radiation increases the risk of developing papillary thyroid cancer.

There’s Chernobyl, where children began getting thyroid cancer in as few as 5 years after the nuclear disaster in 1986. But, it’s not like I’m going to bathe in, drink and breathe radiation in my home, right.

Well, according to the National Institute of Health:

“The rapid increase in CT use since 1990 and especially in the past 10 years has been accompanied by a coterminous worldwide increase in incidence of thyroid cancer especially in women. Are the two trends independent or related? Specific information from many countries and seven American states suggest that the relationship is real as no other cause can account fully for the temporal change in the frequency of this malignancy.”

In a 2006 study from the Washington University School of Medicine about the connection between CT Scans and Thyroid Cancer, Dr. Aaron Sodickson said:

“A patient’s cumulative risk of radiation-induced cancers is believed to increase with increasing cumulative radiation dose. The level of risk is further increased for patients scanned at young ages and is in general greater for women than for men.”

All of which sounds pretty damning, in a very general way.

However, to make this very personal, my cousin, one of the strongest and healthiest people I know, just had a particularly aggressive thyroid cancer removed (along with her thyroid) and endured some pretty hairy medical procedures. She is now dealing with trying to find the right – lifelong – balance of thyroid replacement. It doesn’t sound fun, and is not something I want to knowingly bring on myself.

Why does her story matter? Well, we have a very similar family history – which does not include cancer, anywhere – and she had a car accident in her past. A car accident that involved CT Scanning to her neck and head. And, just as the studies are starting to suggest, she developed aggressive thyroid cancer for no other apparent reason.

So, it’s time for me to follow-up with my neck surgeon. We need to know if my collars, with their ironically BDSM flair, are doing anything. I’m happy to get the MRI, which will show what’s going on with the cyst. It is the CT scan that can tell me if the bone-chip is doing anything that could kill me instantly. But the CT Scan could kill me slowly.

This is an ironic conundrum.

I’m okay with my life as it is right now. Except the constant pain, I’ve gotten used to not doing most of the things I shouldn’t do. I figure that giving up most of them makes the one or so that I can’t give up an acceptable risk. (Yes, I warn people who need to know, but honestly, they are a lot less fun when they know.)

I could get the CT Scan (another 1,100 x-rays) and find out for sure if my neck is better or worse, but what difference would that make? If it is better, then it’s better and I’m still in constant pain, and would know that isn’t going to change. That’s a bummer I don’t need. This way, I can hold on to the hope that the pain will go away. Granted, it would be nice to know that the chip isn’t going to move and kill me instantaneously.

If nothing has changed, then I’ll know nothing is going to change, because it’s been so long. That’s a lot of risk with no reward.

If the bone has shifted in the wrong way, I’ll know I’m another millimeter closer to death, and it may well stop me from having some of the fun I’m having now. Is knowing that death is more imminent really a bonus in any way?

Of course, death is not a guarantee. There’s also paralysis, which I don’t think I would handle well at all.

And then there is the general reality that death is always an instant away. After all, when we were hit, it’s not like we drove into that intersection knowing someone was going to run a red light and nail us. I could have died then. Any of us could. The future is, simply, not guaranteed to any of us! The present is, and it’s a gift that I’m having fun with.

I’m really happy right now. I’m super active, I’m in great shape, and I am very vigorously enjoying my body and all the pleasure that it is capable of. Finding out what’s going on in my neck may change that. Not just because the information about my neck may fuck with my head, but also because getting that information may give me cancer.

Of course, the scan also may show that it’s getting better. Or that it has all shifted just enough that they can do surgery to remove the chip and drain the cyst manually, which would eliminate both risk and pain.

Good gods. I have no fucking idea what to do.

(Oh, did I mention that the driver who hit us was uninsured? There’s no money to deal with this anyway…..  And this is all crazy expensive!)

I need a drink. If I put on a collar, maybe someone will smack some sense in to me and I can figure this all out.

2 Comments leave one →
  1. Toby permalink
    July 29, 2010 5:56 pm

    Generally speaking, CT’s are fantastic at two things… spatial resolution (if you need to know precisely where something is, like a bone chip impinging on your spinal column) and taking pictures of dense tissues, such as bone.

    MRI’s, on the other hand, best differentiate between very similar soft-tissue densities, when the functional properties are different.

    So, an X-ray of pudding, next to jello, next to applesauce would show very little differentiation. But an MRI of your neck would be able to differentiate a fluid-filled cyst, from blood, from spinal fluid.

    Each of these two is the preferred choice for one of your two conundrums.

    Here’s the thing, lots of people who ‘drive’ these scanners do so is if they were ‘point-and-shoot’ cameras. They choose from one of the prepared protocols… the one that they think would be best, and then hit the ‘go’ button. Both are like 497-tool Swiss Army knives, and most people use either to corkscrew or the tweezers.

    You don’t need the GPS coordinates of the bone chip, you need to know where it is relative to your spinal column. And an MRI, driven by a smart, qualified technologist, can do that for you.

    You might really benefit from having your spine doctor refer you to a good MRI radiologist. Most of us, as patients, rarely know that radiologists even exist. Most live their professional lives rarely, if ever, seeing patients, directly. Instead they’re sequestered in windowless rooms reading hundreds of CT and MRI scans per day. You never see them. They evaluate your X-ray and dictate a report, then go to the next in their stack. But when you really need to know what the hell is happening inside your body, and it’s not a ‘clean’ assessment, then you should be able – no, encouraged – to talk with a radiologist. You talk about your concerns (radiation from the CT, which is just a giant rotating X-ray machine) and desires (that the information will somehow be useful in making you better), then ask them what they can do and if they think that CT, or MRI, or any imaging will be helpful to you.

    If, together, you decide to go forward with imaging (either CT or MRI), have the radiologist work with the technologist who drives the scanner to build a set of exam parameters that are going to be tailored to your needs. If you go with the CT, they can adjust settings and reduce the radiation (the pictures aren’t as clear, or the exam may take longer). With MRI, they can get some amazing detail of bony structures by tweaking the settings in real-time as they conduct the exam.

    Know that there’s a long list of us who are rooting for you, whatever you choose.

  2. askyourmother permalink
    July 29, 2010 9:17 pm

    Thanks Toby! I’m pretty much going to print out this comment and take it with me. This is the clearest explanation I can imagine of what I need….. And may allow me to avoid the CT Scan.

Wanna talk about it? Comment away, I'm paying attention.

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: