Monday, July 13, 2009

Steroids and CT scans

A number of you have asked why the "roids" before my CT scan. No, it is not to build my body, or even relieve my arthritis, though it sure does do the later.

Steroids are not part of the usual prep for a CT, unless you are allergic to the IV dye, which I might be.  I broke out in a gentle rash that started the next day. Nothing dangerous, no swelling, no wheezing or shortness of breath, no hives. Just a mild, slightly itchy raised bumpy breakout on my arms and chest. Lasted a few days.

Enough to raise eyebrows. Likely significant, but unlikely to become scary. The irony is that I saw the dermatologist the same afternoon that I had had the CT in the morning, and I had nothing to show him. The reaction was to appear hours later. Most unlikely the next time will be worse, but it is possible. To play it safest, I take premeds, antihistamines and steroids (multiple doses of high dose prednisone), starting the day before. Steroids, especially by mouth, often take a day or more to kick in.

But steroids, as all our CLLers know, can shrink nodes very fast, sometimes over night.  Mine have in the past.

So my dilemma is becoming clear. My scan is to check the size of the nodes, but the premeds could give a false sense of reassurance.

Do I risk a potential life threatening reaction to get accurate data and avoid the prednisone. or do I play by the rules and take a small risk and get the best results?

I suspect those who have followed me thus far, know which way I am leaning. I am leaning way over the rail, to get the best look.

My plan now is to take the antihistamine, and a single prednisone dose maybe 2 hours before the injection. That should offer significant protection, and not effect the results. 

Skipping the contrast injection (non ionic for those in the know) is not an option I am told, as it helps outline the nodes, but a different brand of dye is possible. Some have different osmolality that might make a difference. 

Guess I have my research work cut out for me.  The rads (radiologists) will want to play it safe. especially with a colleague and friend as the patient, so this is going to take some finesse to avoid the full course of allergic prophylaxis, which seems to me to be a bit of overkill.

My plan is to dig a bit deeper.



Anonymous Anonymous said...

Why not have an MRI? Or a scan without contrast? Or a PET scan?

Besides, the radiation amount from a CT scan is significant. It without a doubt causes cancers in humans.

There may be a place in medicine for CT scans, but routine monitoring of lymph node size isn't one of them, in my opinion.

And, whatever happened to microbubble ultrasound?

July 14, 2009 at 7:34 AM  

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