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Thursday, December 15, 2011

Diarrhea from CAT scans: Otherwise healthy, well fed and feisty

Sandy’s story:
I am a 66-year-old cancer patient diagnosed with colon cancer fall 2006, treated with surgery and chemotherapy. My surgical treatment consisted of a partial sigmoidectomy; loose movements are not a post op complication or pattern. Other than some allergies, and some mild, intermittent, infrequent asthma symptoms and aging bones, I am otherwise healthy, well fed, and feisty.

Now, having had several CAT scans, and having passed the fifth anniversary of my diagnosis, the plan is for me to have no more scans unless symptoms should develop that require them.
I was a nurse in the days when the only way to diagnose diseases such as cancers was to “go in” and have “look/see” exploratory surgery. I remember when the first CAT scanner arrived in Boston and the waiting lists for the test. Scans are clearly a far more accurate, “pleasant”, and life-saving tool. Yet I have a hunch that one of their side effects might be underreported.
My first three CAT scans resulted in mild cramping and a few loose bowel movements over the course of several hours. The fourth scan led to intermittent diarrhea over 6-8 hours, with onset approximately an hour after completion of the test, making the interval significantly more unpleasant than previous years. When I shared the observation with my oncologist on my subsequent visit, it was dismissed as not meriting concern.

Prior to my fifth test I began conversing with another elderly patient in the waiting room. She revealed that she lived more than an hour away from the imaging center, and was providing her own transportation. After her previous scan she had severe, sudden diarrhea on her way home, soiled herself, and feared the same might recur. Her medical condition did not involve any problem with her colon. She had been too embarrassed to report the previous incident to her medical team.

My fifth anniversary CAT scan took place in November 2011. For scanning purposes I was asked to ingest barium sulfate. The imaging center that administered the test I believe uses readi-cat smoothies for their patient prep. My scans have usually occurred briefly after noontime.
I was taken for my scan 20 minutes early, had not even completed the second bottle of contrast, but was reassured it “would be all right”. Afterward, I reached home in about 20 minutes travel time, barely “made it” into the bathroom. I had severe bloating, explosive diarrhea, that led to my spending several hours out of the next 6-9 on the toilet. I also experienced mild nausea, cramping, intermittent sweating, late onset “headache” and my “usual” back pain. The experience was far worse than any colonic cleansing prior to previous colonoscopies. There was no sign of an allergic response such as urticaria or wheezing. I did not report the event at the time. My next medical visit is planned for early January; I will do so then.

The technician (for the first time) did tell me prior to my leaving the imaging center that I may experience diarrhea, leading me to wonder if more frequent, more serious cases of it are being reported. When I told her I was aware of the possibility and that symptoms were worse after each test, she replied that she was “not surprised”.

Discussion of the radiologic dosing with respect to scans is common. I do wonder however, at the range of acceptability in side effects for patients undergoing such tests, how often they are actually warned about their possible severity, and whether such effects are either reported or dismissed upon doing so. In a frail, ill, low body mass, or older individual living alone, an episode such as the one I had could have led to a serious medical situation, let alone a simply unpleasant one.

I believe other preparations are available. Of course no alternative is offered if there is no effective reporting and tracking of statistics indicating the need for the substitution.

I wonder how often patients are warned about the possible severity of symptoms, whether increased sensitivity with repeated exposures may be a factor, and if any plans are in place to consider that and offer alternate contrast media in any radiology centers. Of course no alternative is offered if there is no effective reporting and tracking of statistics.

Sandy’s Advice: If you have these side effects from the barium sulfate, Medline and the Mayo Clinic say that you should report that to your doctor or health care professional as soon as possible:
allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
breathing problems
chest tightness
prolonged nausea, constipation, diarrhea or pain in stomach or abdomen

At the very least there should be a “call your doctor if” pamphlet given to patients. Not everyone has other ways of obtaining any or even accurate information other than from their medical care teams. Some patients for varied reasons may not question doctors, technicians, or perhaps even understand the discussion if it takes place.

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