Show me your erosions or else
Some of you may remember last year when we met Dr. Shrug who gave my foot an ultimatum: Show me a bone erosion, or no more DMARDs. We only ever saw the doc once (more than enough). It was Dr. Tylenol’s partner, who they scheduled us with since Dr. T was out.
We saw the report from the MRI. It said my foot was unremarkable. That foot does not have my worst affected joints, but they are obviously affected. I knew the MRI was wrong, but I was helpless to object: I called the imaging center to be sure it had been read properly, and not mixed up with someone else’s scan. End of story.
A few months later, I was copying records for the physical medicine doctor that my GP sent me to… and what I did I happen upon? Old foot x-rays notating joint space narrowing and early erosion.
I don’t read MRI’s for a living, so I can’t tell you whether the MRI itself or the radiologist was in error. But I can tell you that my feet – and the rest of my body – are affected by Rheumatoid Disease (RD), so that the past eight years of my life are entirely different from what came before. Whether or not any particular MRI identifies that.
Remarkable realization about radiology
Of course deep down I knew the MRI report had to be wrong, but there was nothing I could say. They stood by it and I didn’t want to pay for a new scan. If you do a little digging, you can find that radiology is an art, machines differ, and mistakes are common (such as in the x-ray story below).
Last week, I was collecting my son DJ’s records related to his Mondini diagnosis and I had to pick up a disc of a CT scan at another imaging facility. It came with a report. I brought the disc and the report to Roo’s doctor and never thought to look at the report – I knew what was in it – his cochlea only has 1.5 turns instead of 2.5… old news. But then I slid the paper out from the disc jacket and read: “cochlea have an unremarkable appearance.”
I’d already read the other specialist’s evaluation “The cochlea bilaterally appear hypoplastic… The cochlea bilaterally are incompletely developed. They have approximately one and a half turn and this is symmetric.” That is one of the three features of classic Mondini.
The local doctor had misinterpreted the scans. The other specialist who evaluated them had commented to me about the poor quality of the scans, and I remember being surprised that MRIs and CT scans (we had both) could be done poorly. They tell me the magnets are various sizes and machines have to be calibrated, but that’s all I know. Maybe a radiologist or radiology technologist would like to comment.
What can clinicians take away from this story?
1) Test results may be informative, but can also be subject to error.
2) Don’t dismiss a patient’s symptoms based on a test. Treat the patient, not the test.
What can patients take away from this story?
1) Imaging is very expensive unfortunately, so it’s not likely that people can get scans repeated easily. However, if you doubt the results of any scan, ask your doctor to request it be re-read. If you have a supportive doctor, that would be a good first step.
2) Save your old reports so that you can compare them to new ones. This is also true for lab reports. When one lab said I had a zero anti-CCP level, my GP and I both new it was an error since I had a half a dozen noting “>250.”
We’re not the only ones who’ve met a Dr. Shrug. It’s so important that you don’t give up. I clung to that after Sara commented “My doctor shrugged it off after the blood test. If the pain in my hands wasn’t so debilitating then…” Continue reading… Don’t Give Up
It’s an important lesson – don’t let the x-rays fool you. A few years ago, we helped a friend after a terrible fall. “None of the doctors doubted the x-ray machine or x-ray technician or the doctor who read the x-rays. I am afraid that the only one who was doubted was my…” Continue reading… Hysterical Symptom Diagnosis, Part 1
- Inadequate & stupid? No, just a victim of someone’s training
- Inventory of Rheumatoid Disease: One Patient’s Experience
- Mondini Syndrome Is Just Deafness Like RA Is Just Arthritis. Not.