Told to have CT scan 3 months post op then every 12 moths! is this normal??!

[sunonwaves]

Hi all

Hoping we can get your thoughts on this situation..
My fiance is feeling concerned as he had his first visit to see the surgion since the op.
The surgion said he feels happy with his progress and that he would like to have a CT Scan in 3 months (the op was a month ago) and then another one at 6 months and then one every 1 - 2 years after that.
Considering that he is only in his early 30's and has had 3 CT scans in 12 months now, he is really not wanting to have another CT Scan again unless it 100% has to be done.

He didnt want to have a CT scan before the operation and would have much preferred a MRI however his surgeon said it was to difficult to organise a MRI :confused2: and said it wouldnt give as much detail, so he went along and had the CT scan.
Due to complications with the surgery (Bentals procedure) he is now pacemaker dependant, so he cant have MRI's fro now on.

We mentioned to his surgeon that he really didn't feel comfortable with having so many CT scans planned in the future, and the surgeon didnt say anything and just booked it in for a few months time from now, so we thought we had no other choice, that was until we started looking around this forum we have since found that most people who have had the same procedure have never had to have a CT scan post op, and most just have an echo, which he would MUCH prefer.

He has had at least 5 echos post surgery and they have all looked fine, he just had some fluid which has gone down now.
We are just confused as to why he demands CT scans when it sounds like there is a possibility to be able to have echos instead.

Its not that the surgeon thinks there is a worry with the surgery, he simply seems to think its general procedure.

We are quite confused by it all and would love to get your feedback and see if you had a echo or xray or CT scan after your op, and your thoughts on the situation

Thanks in advance!

 

[Duff Man]

If your surgeon says you should have a ct scan at a certain interval and you trusted him to do open heart surgery on you, then you should probably trust him to make a call about the ct scans too... just my two cents. While there is no 100% safe dose of radiation, the benefit of scanning a recently resected aorta once or even a few times postop will probably outweigh the risks of cancer from the same amount of scans I bet. I personally try to remember that cancer patients receive dozens or even hundreds of times the radiation dose in a chemo treatment compared to a regular ct scan... it puts things in perspective. Maybe my math or information is wrong, but the doses cancer patients get make them physically ill and it damages their internal organs. CT Scans just don't tend to do that.

At the end of the day it's your husband's call, but Icarus might be our best fable for this situation.

 

[kfay]

It's funny you mention this because I just was having this type of conversation last week with my very good friend who, luckily happens to be a radiologist. I had been to a dinner party the night before where one of the people there sells the equipment that goes into cardiac cath rooms and he was rattling on and on about how much radiation there is in those rooms, which started freaking me out, because over the course of my life, I have been in those rooms way too many times. Not to mention, when I was younger, the sometimes weekly chest x-rays, I started freaking out about the amount of radiation I may have been exposed to over my life.

Anyway, I called her the next morning to ask her opinion about it and she said that although I'm really the first generation of congenital patients to make it adulthood in any real numbers, she was sure she would have seen a study if there were any real problems related to the amount of radiation we had all been exposed to. Then she said, "You have to realize there are cancer patients that we give CT's to every month now, and that is much more radiation than you have been exposed to and they are fine." So, 4 a year is much less than that, and if you are really concerned, I would express that concern to his surgeon and maybe over time, you can decrease that to once or twice a year.


Kim

 

[catwoman]

I have never had a CT scan.
I've had an annual echo since my MVR and in 2007 and 2009 had a TEE following those echoes.
I have read several articles (can't remember where or in what type of publication) that indicated too CT scans are being ordered needlessly, that safer, less expensive diagnostic tests are available.

I would love to know if doctors profit from tests ordered. They do if the diagnostics are done in their office, but I'm not sure if the tests are done elsewhere. In the U.S., many physicians groups are owned by groups that own hospital systems.

I willl have to pose that ? to a few people I know who are in the medical profession.

 

[sunonwaves]

Thanks for your input.
Im aware that they use alot of radiation for cancer patients, and to be honest Im not the greatest fan of it for healing cancer, Im more for the gerson method and beating it naturally instead of radiation therapy, however thats another subject

My point is more that if there are other options, and theres no real reason why he needs to have a CT scan, then he would off course prefer to have a base line echo, especially when he has read that other people that have had the same op have not had to have a CT scan at all after surgery.
Its not that the surgeon is concerned, he said everything seems fine and its just for the usual check up.
Regardless on whether people personally feel that the radiation is harmful or not, its more that we would like to know if other people were asked to have a CT scan after their op or not.
We have also been advised by 2 doctors now to not be swayed in to having CT scans unless they are 100% necessary, one of the last doctors we saw was horrified to hear that he was made to have 2 CT scans already for something that he said was really unnecessary.

So we would love to hear if anyone else has been asked to have a CT scan after their op (for just a general check up when they have already been given the all clear) or have you just had echos?

Thanks again

 

[sunonwaves]

Thanks for your input catwoman, I have also heard from people in the medical industry that CT scans are used far more often that needed and they are putting people at risk unnecessarily. (google unnecessary CT scans and a heap of news stories should pop up)
Thats a interesting point re profit from tests ordered. I think in our case it was more that it was / is the easiest option for the surgeon and he's quite old school, and really wasn't open to hearing our concerns. When we mentioned our concerns re radiation he said he wished they never to the public about the harmful radiation levels from CT scans..

Anyhow I was told by a doctor that a chest CT scan is equal to 400 - 600 chest xrays :thumbd: not exactly something my partner wants to put his body through unless its absolutely necessary. :angel:

 

[ALCapshaw2]

Hmmm....

My first question for your Surgeon would be "What is he looking for?"

CT's (and MRI's) are the Gold Standard for checking the Aorta for signs of Aneurysms.

I would wonder if your Surgeon is wondering about the possibility of a Connective Tissue Disorder which can result in Aortic Aneurysms. IF you have a CTD, did he 'miss the signs' when he was in there?
Or, did he choose NOT to address weak/defective tissue in the Aorta when he did your Valve Replacement?

A Second Opinion from another Surgeon and/or Cardiologist would NOT be out of order.

'AL Capshaw'

 

[sunonwaves]

Hmmm....

My first question for your Surgeon would be "What is he looking for?"

CT's (and MRI's) are the Gold Standard for checking the Aorta for signs of Aneurysms.

I would wonder if your Surgeon is wondering about the possibility of a Connective Tissue Disorder which can result in Aortic Aneurysms. IF you have a CTD, did he 'miss the signs' when he was in there?
Or, did he choose NOT to address weak/defective tissue in the Aorta when he did your Valve Replacement?

A Second Opinion from another Surgeon and/or Cardiologist would NOT be out of order.

'AL Capshaw'

Nope, he never mentioned any of those things, he simply said everything seems fine, he's happy with how it has all gone and that after he does his surgery he likes to see how it all looks with a CT scan and then he likes to do that every year or two (CT scan again)
That may be how he likes to do it, however since we have seen on this forum that no one else seems to have to have a CT scan post op (unless theres an issue, then off course we would be open to it) we feel we would like to be able to choose another option such as an echo...is that unreasonable considering that there is no specific issue that he is looking out for and he feels totally happy with everything?

I think you may be right re talking with another surgeon / cardio

 

[Lynlw]

I tend to agree with you and wouldn't want to have yearly CT scans if it isn't necessary. My son has had 5 Open heart surgeries and has only had 1 CT scan and that was looking for something specific not as a routine test.

He has had Echoes every year or so and a couple Cardiac MRIs. I'm a little confused. Is the surgeon going to see him the rest of his life? Usually after the recovery period from surgery, the yearly check up are done by the cardiologist and we never see the surgeon again unles they need surgery.. What does his Cardiologist recomend? IF they insist on follow up CTs, I would ask if they could at least be done every so many years and have echos yearly. Even just 30 more years of CT scans is ALOT of raditaion. and yes, Cancer patients get more, but I also know many that have some kind of problems caused by the radiation OR even got a new form of cancer years later

IF they won't budge, I personally would be looking for new doctors to at least get 2nd opinions.

ps didn't he have both a valve and the root replaced?

 

[Jkm7]

I have never had a CT scan.
I've had an annual echo since my MVR and in 2007 and 2009 had a TEE following those echoes.
I have read several articles (can't remember where or in what type of publication) that indicated too CT scans are being ordered needlessly, that safer, less expensive diagnostic tests are available.

I would love to know if doctors profit from tests ordered. They do if the diagnostics are done in their office, but I'm not sure if the tests are done elsewhere. In the U.S., many physicians groups are owned by groups that own hospital systems.

I willl have to pose that ? to a few people I know who are in the medical profession.

While it is true that many medical groups own clinics and treatment centers, it's also true that hospitals have bought many private medical practices. I'm sure there is profit on testing done in physican's offices. But I don't have a problem with that. If they are expected to accept such low payment for medicare /medicaid patients, they are also entitled to have areas for profit. How much is a whole subject unto itself.
Our medical system in U.S. is ohhhh so complicated and about to get even more so, I imagine.


OP...... I've had two OHS and never had a CT scan and would not be eager to. I would try dragging feet a bit about the appointments the surgeon sets up for all these scans. If you don't feel comfortable about having so many scans, you certainly can decline.

Trust your instincts and hear your 'inner voice'.

 

[Bill B]

5 echos post-op is a lot more than usual too, although not harmful. As AL mentioned, there are some things that chest CT or MRI are needed to see, such as aortic aneurysms beyond the root. Perhaps the surgeon has some concerns about potential problems in these areas. He really should be willing to explain it. My surgeon used CT with contrast once before surgery rather than angiogram to delineate my aneurysm and my coronary arteries. Also, he ordered another CT a few days post-op. But that's it. One echo a few days post-op and then 3 months later, 6 months later and now only once a year. Anyway, the surgeon should be willing to explain his CT order. You have every right to be concerned about radiation exposure.

 

[Bryan B]

You said every 1-2 years after these initial CT's. I think that is infrequent enough not to worry about it. In order to see the ascending aorta your two realistic options are a MRI or a CT. Since the MRI is out due to the pacemaker the CT is really your only option. An echo gives a great view of the valve and a decent view of the root, but there is too much body mass to get a good look at the ascending aorta (this is what I was told by my cardiologist and surgeon). My surgeon follows his patients for life. Before my surgery he did a CT scan. I asked him why not a MRI and he said the CT scan is the gold standard for getting the clearest pictures. Having said that he will be doing MRI's annually on me. I guess if he sees something he didn't like he would then do a CT. BTW when I had the CT before surgery my numbers were way higher than the echo I had before surgery and a little higher than the MRI I had. When he actually did the surgery they were even higher than what the CT showed.

 

[Superbob]

Not until nearly five years after my surgery did I ever have a CT scan. I had moved to a new location and my new cardio thought he detected an aortic aneurysm on a routine echo. He had a Ct scan done. I got film of all the tests and sent them to my surgeon back in Virginia. In his opinion, it is not an aneurysm; rather it is the replacement device he implanted workly properly. Nevertheless, my new cardio wanted six-month repeats -- an echo, then a CT scan if he still considered it suspicious.

I have no doubt the CT scan is the gold standard for aortic aneurysms, but I don't want to be regularly getting that much radiation unless there is a clear reason to be doing so. Therefore, I have recently changed to a new cardiologist in hopes he will at least consider my surgeon's findings.

In short, I think it is reasonable for you to be concerned about the cumulative effect of multiple CT scans, though of course in some cases they may be medically necessary.

 

[Herb_Webb]

I'm with several posters on this one....What exactly is he looking for? My surgeon and cardiologist recommended echocardiagram once every 3 or 4 years. I was 39 at the time. The only change in this schedule has been recently due to an arrhythmia (atrial flutter) that has come about. If it were me, I'd do the annual physical and if anything serious was discovered I'd bail on getting radiated. I hate it when they say we just want to be sure, especially for CTs and xrays. There is a phrase that doesn't get used often enough, "I'd like a 2nd opinion on that".

best of luck

 

[jake]

I hate to seem like I am second guessing a doctor, however, after having had like 6 CT's in the past I am furiously bucking any more in the future! Lots of radiation comes along with any CT Scan and consider that not all CT's are the same.

Most CT scans for us cardiac folks include contrast die which is Iodine based. Where the rub comes is when a doctor has the CT done of just the chest or abdominal regon or both. Than there are other doctors who want these regons done WITH contrast die AND WITHOUT. Consider that if your doctor says that he wants a CT done of just the chest and only with die, your radiation exposure is monumentally less than if the doctor orders a CT of chest and abdominal with and without die.

If your surgeon is frugal with the area involved and only with die, we are talking about a lot less radiation than a study done with all the bells and whistles.

Also keep in mind that cardiac MRI's are not without risk either! The imaging die used for MRI's is called Gadolinium and its known to cause NSF (Nero Cystic Fibrosis) in people with impaired kidney function.

The CT die, in my case, trashed my thyroid!

The bottom line is that you have to do a lot of research and get many opinions! Personally, if I had a surgeon who was asking for as many CT's as yours is asking for, I would go looking for another opinion.

Final thoughts....the effects of radiation are CUMULATIVE. The frequency is meaningless. There is NO SAFE AMOUNT OF RADIATION! People will tell you that you get as much radiation on an airplane flying from New York to Los Angelis as you do from a chest CT. What they don’t tell you is that the radiation from airplane travel is not focused on your chest cavity! It’s also not the same radiation and no one is injecting iodine in your body when you are seated in coach.

You are 100% right to be concerned about the amount of radiation considering you may need more CT's in the future!

 

[Jeff Edmonton]

I had one CT scan done 2 years ago, I had an echo done before the CT scan and the technician was wearing a radiation dosimeter ring on. I questioned her about the ring and she looked at me sheepishly. When I returned to work the next day I used a geiger meter to test my radiation level and I was to hot to work around.

I believe that pacemakers are not MRI friendly, I would be looking for a good cardiologist to get some real answers.

 

[BackDoc]

CT scans are radiation dose over time. using contrast also adds an additional load to the kidneys which must clear the contrast medium from the body. I had one Scan 3 months following surgery, then a follow up scan 1 year later. I am going on my 4th year post surgery. I have an annual echo. I would question the frequency of the recommended CT's.

 

[Michelle D]

I was instructed to have echos done at 3 months, and then once a year. I only had CT's when I was having lung issues afterwards but perhaps different valves need different types of check ups.

 

[Duff Man]

I hate to seem like I am second guessing a doctor, however, after having had like 6 CT's in the past I am furiously bucking any more in the future! Lots of radiation comes along with any CT Scan and consider that not all CT's are the same.

Most CT scans for us cardiac folks include contrast die which is Iodine based. Where the rub comes is when a doctor has the CT done of just the chest or abdominal regon or both. Than there are other doctors who want these regons done WITH contrast die AND WITHOUT. Consider that if your doctor says that he wants a CT done of just the chest and only with die, your radiation exposure is monumentally less than if the doctor orders a CT of chest and abdominal with and without die.

If your surgeon is frugal with the area involved and only with die, we are talking about a lot less radiation than a study done with all the bells and whistles.

Also keep in mind that cardiac MRI's are not without risk either! The imaging die used for MRI's is called Gadolinium and its known to cause NSF (Nero Cystic Fibrosis) in people with impaired kidney function.

The CT die, in my case, trashed my thyroid!

The bottom line is that you have to do a lot of research and get many opinions! Personally, if I had a surgeon who was asking for as many CT's as yours is asking for, I would go looking for another opinion.


You are 100% right to be concerned about the amount of radiation considering you may need more CT's in the future!

Jake, how do you know it trashed your thyroid? Did a doctor say that? I'm just curious how you came to that conclusion.