BY A PATIENT OF MARK SCHOLZ, MD
When you
go fishing, you can bring up all kinds of things besides fish—old rubber boots,
pieces of a broken net and discarded trash. Once I caught an eel. You never know what you will drag in when you
drop your line overboard.
The same
analogy holds true for diagnostic testing in the medical world. Investigative
studies can have unintended consequences. Of course the studies seem justified
at the time. We presume that the doctor is being rightfully conscientious by
using all the tools of modern medicine, “fishing” for the right answers.
Dr.
Scholz asked me to relate the story of an extended medical fishing trip that
started with my dermatologist for my annual, too-much-California-sun screening.
While talking to my dermatologist, I mentioned some itching on my arms. He gave me a few samples of lotion and
referred me to my internist for further evaluation and blood testing to “make
sure” the itching wasn’t a symptom of something more serious. My internist
ordered some lab work (which was normal) but recommended that I have a routine
chest x-ray since itching can be associated with lung cancer. This suggestion may have occurred to him
because he knew that lung cancer caused my mother’s death. Since I hadn’t had a chest x-ray in years, I
thought, “why not?”
In
retrospect, the chest x-ray may have been a mistake. Because that’s when the boat left the dock
and the fishing really began in earnest.
Two days later, the chest x-ray revealed a “suspicious” spot on my lung.
So, to identify what it was, a CT was ordered. The spot was benign. “Whew!” It was only a
bone artifact (the end of a rib visible due to the angle of the x-ray). But…. the CT scan showed a suspicious spot in
the liver, which shouldn’t have been there and was large enough to be of
concern. So, an MRI of the abdomen was
ordered. The MRI revealed that the liver
spot was nothing but a harmless hemangioma, a collection of blood vessels that are
common and mean nothing. Another big
relief. But…. guess what else the MRI found?
At the top end of the scan in my lower neck, it showed some
abnormalities in my thyroid “that could not be ignored.” So, a thyroid ultrasound was ordered. It revealed two nodules that looked benign
and would have been ignored completely if there had only been one. But the
only way to really know what types of cells the nodules consisted of was by
doing a needle biopsy or an exploratory surgery.
Yikes! When would I get off this merry-go
round? Who could imagine that simply
mentioning some itching to a dermatologist would lead me face to face with the possibility
of thyroid cancer. However, the doctor
was kind enough to offer another alternative.
Because of the known, slow-growth rates of typical thyroid cancers, active
surveillance and re-testing at future intervals was also an option, and the one
I have selected.
So, six
months later, a second thyroid ultrasound—my fifth imaging test—showed no
changes from the previous test. The
fishing trip finally seems to be over. I
am back in the waiting pool anticipating next year’s medical expedition, much
the same as the next round of prostate screening tests I am scheduled to
undergo early in 2017. Now, routinely
surveilling my thyroid is going to be just like my prostate. If next year’s fishing trip doesn’t run down
any new tributaries and is uneventful, I expect it may even be possible to extend
by a year or two the time the frequency of testing.
My medical
fishing trip was not much fun. Personally,
I’d rather spend my time working, biking or walking, or doing almost anything besides
waiting for the next set of results from the last odd thing that showed up
unexpectedly. But life goes on and it isn’t possible to know precisely how it
will end. My recommendation—Give careful
consideration to your doctor’s invitation to go fishing. Take control over your medical destiny and
ask you doctors if close surveillance is an alternative to further testing.
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