Wednesday, May 10, 2006

TYPICAL

A really nice person I work for is an M.D. radiologist from Austria (or Germany). He has been doing mostly clinical work with some consulting on other researchers’ projects, but he is expanding his research effort and starting to lead projects of his own.

Yesterday a nice co-worker asked if I’d be a Guinea pig for one of my guy’s clinical trials that requires healthy-man-my-age knee scans. I gave her a hard time, but she met my requirements—that it take place during my regular work day, and that the MD radiologist review the scans for any obvious pathology.

So I spent the last two work hours in the Imaging Center downstairs in comfy hospital gown things, and most of that time flat on my back with my eyes closed, listening to the compelling aleatory music of the 3-T MRI machine—thumps, clangs, knocks, and hums in various competing rhythms and all ridiculously loud. Earplugs are required. Many actual patients need to be dosed for claustrophobia, so the controlled opportunity to deal with my own claustrophobia is an additional benefit. It really is reason over reflex.


The opening starts wide. You can see that it narrows. The actual scanning gets done deep in the dark narrow tube. I've always gone feet-first. The guy in the picture is about to be slid-in head-first--they'd have to knock me out with a sledge hammer.

This afternoon my MD radiologist called me into his office to talk about my scans. He seemed kind of concerned. He said I had significant edema (swelling, I guess) in two places. He asked me if I had any knee pain and was surprised that I said no. He asked about my tennis (my being an “active” 50-something made me an ideal Guinea pig), if my knee felt sore after playing. I said, no not at all.

I mentioned that I’d had some foot problems, some plantars fascitis and a little tennis toe, but even after twenty years of softball and seven years of tennis, I had no knee pain at all. He still acted very surprised. He had drawn a simple diagram of where the edema showed up, and explained why it could (should) be painful. Then he wanted to show me the actual scans.

I pulled my chair up to look at his computer screen over his shoulder. As he moved through the first series (the process produces 2-d images of the object from hundreds of angles—the effect of moving through a series of images is that of walking around a statue, or turning an object in your hands) he again expressed surprise.

What he saw was a perfectly healthy knee, no pathology whatsoever. Turns out he had originally looked at only a few printouts he'd been given in a folder. The printouts he'd seen were of another person’s knee. Somehow there'd been a mix-up. After verifying that the scans on the screen were my true scans, he seemed relieved. Apparently the (wrong) scans he had looked at that morning contained some fairly bad news.

He apologized for causing alarm. “As long as we caught it before the amputation,” I quipped.

Actually I hadn’t felt alarmed. If there had been a real problem I was lucky to find out about it. MRI scans are expensive and would normally not be available to me. Then, learning that my knee is actually ok, that’s fine, too. Full speed ahead.

But it’s a valuable cautionary tale. When it does it come time to amputate something, I’m going to make damn sure they’re looking at the right scans.

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2 comments:

sfmike said...

I don't think my knees are going to hold out as well as yours for purely hereditary reasons (my mother and grandmother both have/had artificial hips/knees) so I may have to give up tennis again. It's a tricky business knowing what's good for you and where you're pushing it dangerously.

And your tale is VERY instructive. I discovered some skin cancer on my nose a couple of weeks ago and the physician's assistant who I trust said, "well, usually, we send people with this kind of cancer to UC where they do exploratory surgery and there's lots of stitches and a fairly involved process, and somehow I don't think you're going to go for that." After I stopped laughing, I asked him, "How did you ever guess? Let's start scraping and burning now." He took care of it just fine and I was spared the horror of "this is how you take a nose apart" at a teaching hospital. As the guinea pig.

Anonymous said...

I say briefly: Best! Useful information. Good job guys.
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