Should I go get the CT scan or not?

October 4, 2007 7:46 PM

Should I go get the CT scan or not? I've had a stomachache for 10 days and my doctor thinks it might be my appendix; the blood tests are all negative; should I still go through with this?

I've been having bad stomach pains for 10 days now. Actually, I've kind of had them on and off for about a month, but they settled in 10 days ago and haven't gone away. Yesterday, I finally caved in and went to the doctor (OB/Gyn.) She checked out all my girlie bits & kidneys and they're fine. She thought it was very possibly my appendix getting ready to go. So she gave me a bunch of blood tests, a pain prescription (which I didn't fill) and an appointment for an abdominal CT scan tomorrow. She wanted to do it today but I was looking at a huge day at work and refused. The CT test involves fasting after midnight and then drinking 2 giant jars of barium dye and being in a machine for 2 hours or so. I'm sure it's insanely expensive.

The blood tests came up negative for everything. There's no high white blood cell count, my liver is healthy, I don't have any diseases, my cholesterol couldn't be better and, well, my blood is a vampire's perfect wet dream.

My stomach still hurts, but not as badly. I don't feel well, but I feel okay - as in, I can eat, poo, sleep and walk around: I just don't enjoy much of any of it since my stomach hurts. I want to cancel the test tomorrow. Partly because I just don't want to do it, being afraid of such things and partly because I'm afraid that my insurance (BCBS, NC version) won't pay for it when they learn that my blood is all healthy. I tried to get my doctor's office to find out whether or not they would pay for it all day to no avail. In addition, my mother told me tonight that one of her cousins had a chronic appendix that flared up now and then for 40 years before it blew. I don't want to have surgery unless I'm dying, frankly, so if this is just going to quietly go away, well, hell. And maybe it's a virus?

But on the other hand, 10 days is a long time to have a migrating, moving, usually just bearable but occasionally really. fucking. painful. stomachache. So what do I do? Get the CT scan or cancel it?

posted by mygothlaundry to health & fitness (29 answers total)

go to your doctor. Oh wait, you did. Well then, listen to your doctor.
posted by garlic at 7:52 PM on October 4, 2007

Get the scan. They aren't as bad as they sound, I don't think.

Everyone on AskMe always recommends going to a doctor--well, you need to listen to the doctor, too.
posted by DMan at 7:54 PM on October 4, 2007

The doctor hasn't gotten back to me on whether I really need to have it or not, given the healthy blood stuff. That's a big part of why I'm asking.
posted by mygothlaundry at 7:56 PM on October 4, 2007

About eighteen months ago, I started having stomach pains just like you describe. It took a lot of visits to the doctor to finally determine that I had "duodenitis," which is damage to the duodenum (where the stomach meets the intestines). We still have no idea what caused it, but man, it effing hurt. (I even tried an acupuncturist to deal with the pain.) I had a lot of tests along the way - multiple h-pylori tests to look for the ulcer-causing bacteria, sonogram to see if I had any tumours, endoscopy to actually look at the damage - and I don't regret any of them. Stomach pain really, really sucks, and you want to be sure you know why you're having it so they can fix it. (For me, that involves taking Nexxium and seeing the doctor for antibiotics when it flares up, because somehow it seems to get triggered by random infections for me.)

I know that the doctor checked my appendix when I had the sonogram. I wonder if that would be an option for you. It certainly sounds cheaper and easier than the CT test!
posted by web-goddess at 7:58 PM on October 4, 2007

Well, in light of that, I'd say you should ask your doctor what to do.
posted by DMan at 8:02 PM on October 4, 2007

I should clarify here - I had a sonogram at the doctor's office; it was fine but they were looking at the uterus/ovaries/kidneys. Apparently they didn't see the appendix there? They acted like they hadn't seen it. Also, this wasn't my regular doctor, who's out of town - this was her fill in, who seemed totally nice, but doesn't know me. And, and this is a big and, I'm still paying off gigantic medical bills that Blue Cross decided after the fact not to cover for my son's arm surgery 3 years ago. So I'm really, really wary of getting hit with sudden bills that I cannot possibly afford.
posted by mygothlaundry at 8:05 PM on October 4, 2007

The actual CT scan part isn't bad. When I did it they also had to run an IV to inject a dye in addition to the drinking of the 'juice'. In my opinion getting the scan was easy and painless. With the wait time it might be 2 hours, but the actual time in the machine is perhaps 5-10 minutes.

My insurance plan completely spells out what they'll cover and what I have to cover. I'm sure you can give them a call and ask if you're concerned about the financial impact.

I'm my opinion don't mess around with internal problems, especially ones that fairly much knock you on your butt for 10 days.
posted by dereisbaer at 8:06 PM on October 4, 2007

Also, I called the doctor five or six times today and didn't get an answer. I didn't get the blood test results until 4:00 pm, finally. I have to make up my mind whether to have the test or cancel by 8:00 am. tomorrow.
posted by mygothlaundry at 8:07 PM on October 4, 2007

I had to have an emergency appendectomy two years ago. I was about to get peritonitus from an abcess on my appendix. They took all the blood tests, and nothing abnormal showed up. But they did the CT and it showed that I needed to get it out fast.

I thought the barium stuff would be awful, but it really wasn't that bad (maybe it's because I just wanted to get it all over with and get my appendix out as fast as possible, and I knew they couldn't do that until I had the scan). My CT scan only took about 10 minutes and they had the results back about 20 minutes later. Basically an infected appendix and abcess about to burst. The surgeon and my doctor were talking about how you never can tell from just the blood work.

So, get thee to the CT scan, stat! Believe me, if it's your appendix you don't want to wait until it gets worse. The pain was excruciating.

Try calling Blue Cross to see if it will be covered. I think they'll be able to tell you better than your doctor's office. I think you could make the argument that it's the only definitive test for appendicitis, since most surgeons won't remove an appendix until the patient has a CT.
posted by la petite marie at 8:14 PM on October 4, 2007

Find out if BCBS SC needs to issue your docs an authorization number for the test. Either call them or try to work your way through the 'my insurance manager' section on their webpage.

A lot of the insurances are making all the damn ordered tests go through 'medical review' first, which is bad for you and bad for the place doing your exam - it means until their docs go through your paperwork, they won't authorize the test. Regarding the bloodwork, your doctor needs to have written something else than ?appendicitis for the reason for looking for it. The negative bloodwork will make that seem stupid (well, there's no point in looking for it, the blood test shows it's not that) and not pass review. If your doc wrote in vauger but potentially serious symptoms, it has a better chance of passing.

Personally, I'd try to delay the CT until you know it's going to be covered. OTOH, that's the kind of test that might find something else. So I wouldn't not have it, I'd just delay it.
posted by cobaltnine at 8:20 PM on October 4, 2007

Another thought. Although the CT is very expensive, if it is appendicitis and you wait, you risk having it burst. Even with my condition, my surgeon wasn't sure he'd be able to operate laparoscopically due to the infection, in which case the operation would have been much more serious, with more (expensive) time in the hospital. Basically, things get more complicated the longer you wait (if it is appendicitis).

I'm really not trying to scare you, just tell you what happened to me and what I was told.

Best wishes.
posted by la petite marie at 8:21 PM on October 4, 2007

I am not a doctor. That said, I don't share the implicit faith in doctors that other respondents seem to have. Personal experience has shown me many cases of poor diagnostics and even flat out ignorance even on the part of specialists (actually, specifically on the part of specialists) in the absence of of more specific tests.

A CT scan will provide you with more reliable information on which to base any medical decision. Get the scan. Read the radiologist's report. Do some research, and then, including the advice of your physician, make your own decision.
posted by Neiltupper at 8:26 PM on October 4, 2007

What about a gastroscopy to rule out stomach problems (duodenitis as suggested earlier)? I lived in the US a while back and had severe abdominal pain. Despite every contrary evidence, my GP kept banging the appendicitis nail. Got a CT scan and everything. They never found anything. Back in Canada, my regular GP was flabbergasted that they would even think of doing a CT scan to diagnose appendicitis. He thought it was done out of either ineptitude or fear of being sued if they missed something important. Consider that a CT scan is A. very expensive, B. involves a heck of a lot of radiation. Bottom line: I would go see a specialist in internal medicine for a second opinion.
posted by bluefrog at 9:06 PM on October 4, 2007

Having had peritonitis and a ruptured appendix when I was 13yrs old - and almost dying , after falling over on the way to chool and feeling like I was shot in the gut, I can say categorically, that if theres a small but reasonable chance that you have appendix probs, get it checked out.

IANAD: listen to yours.
posted by lalochezia at 9:36 PM on October 4, 2007

50 years ago, the phrase "exploratory surgery" wasn't uncommon, particularly where poorly localized abdominal pain was the primary complaint. Today, CT and MRI scanning has all but eliminated the need for surgeons to open you up, to look inside you, to see what may be wrong with you. So, I, for one, am a big fan of advanced medical imaging. And I disagree with bluefrog that a CT will represent "a heck of a lot of radiation." Probably no more than 2 or 3 normal chest Xrays, or about the increased dose you'd get taking 3 airplane trips, NYC-LAX.

On the other hand, if you are experiencing appendicitis, and your appendix bursts before it is removed, you are in for a lot of (unnecessary) pain, and complications like periontitis and sepsis, which, even in an age of modern antibiotics, are nothing to fool around with, if you can possibly avoid them. So, while I understand your financial concerns regarding the price of a CT scan, as a layman, I'd still suggest you have the test.

If you can't get an answer regarding BCBS benefits from your benefit manager or BCBS hotline number, and your pain increases, at all, don't be shy about reporting yourself to the ER. When an appendix goes, it goes, and if you have any time to get yourself to a hospital, that time will be measured in hours, not days.
posted by paulsc at 9:45 PM on October 4, 2007

IAAD, but IANYD. The blood work doesn't really help out, if your examination and your history really suggest appendicitis. There's no way to know over the internet whether you clinically look like appendicitis so we have to go with the opinion of the doctor that saw you (hopefully you chose a competent, experienced doctor you can trust). 10 years ago, before CT was widely used, if your doctor suspected appendicitis, you would probably already be in surgery by now.

Even if the CT was negative and you took half the day off and had to deal with insurance hassles, wouldn't you still be relieved to know that you didn't have anything that could put you in the hospital or even kill you?
posted by Slarty Bartfast at 10:28 PM on October 4, 2007 [1 favorite]

IANAD, but to my mind, the normal blood work is more reason that you should have the CT scan, rather than a reason not to.

Medicine is often a process of ruling out various possibilities. Normal blood work does not mean you're fine, it means that a certain set of possible causes has been ruled out. Now you need to take the next diagnostic step, in this case a CT scan, to either find an answer or rule out more possibilities.
posted by platinum at 10:30 PM on October 4, 2007

IANAD: Get the tests.

Do you still have a gall bladder?

I had abdominal pain on my left side for many months. The gall bladder was ruled out because of the pain location. During my third ER visit for extreme gut pain, a visiting doctor ordered an ultrasound and saw that my gall bladder was diseased and operating at <1/5 of normal. A few days later I had outpatient laparoscopic surgery and resolved the issue.
posted by bonobo at 10:35 PM on October 4, 2007

Hey mygothlaundry. I would go ahead and get the CT. I had it and I had my appendix out, and I was happy I did. I got the blood work. It was inconclusive. I then got the CT. It was also inconclusive. Then I just said fuck it, take it out. And they did. And, just so you know, I got it out in Asheville! It was a very pleasant experience, and I had a super-hot doctor and we talked about music and shit. Overall, a pleasant experience. And I got to watch the sunrise christmas morning over downtown asheville from the top floor of the hospital. It was actually one of the better christmases ever.
But, FWIW, I had BCBS NC, and it wasn't cheap. I guess it just depends on your plan. I had a pretty shitty plan.
Good luck. If you indeed have the surgery, the pain before is much worse than the pain after. I was shopping on Lexington Ave the day after Xmas (two days after surgery).
posted by greta simone at 11:00 PM on October 4, 2007

Only you know how much pain you're in, so I'm sort of assuming it's in the "bad but bearable" category, and not debilitating.

Personally I would wait and not get the test until you're sure your insurance will cover it. Call them up, lay out the situation, and make sure you get approval from someone. Preferably in writing (via fax, if you have access to one; your doctor's office almost certainly does -- get their incoming number to give to the insurance people). Document, document, document.

Your insurance may also be able to refer you to an internist for a second opinion, which might not be a bad idea.

But if things start to change at all, get thee to an ER. (Might want to read up on your policy's emergency coverage so you can make sure to do whatever's required to get that paid for as much as possible, too.)
posted by Kadin2048 at 11:49 PM on October 4, 2007

Do you still have a gall bladder?

I second this. Did your doctor consider gall stones?
posted by Violet Hour at 12:50 AM on October 5, 2007

"The effective radiation doses with diagnostic CT have been shown to be similar to the amount received by Japanese survivors of the atomic bomb, who showed a small, but statistically significant, increased risk of developing cancer as a result of the radiation.1,2 Nonetheless, this study from Yale University shows that physicians and patients are not fully aware of the radiation dose and the risk associated with CT scanning."

And I disagree with bluefrog that a CT will represent "a heck of a lot of radiation." Probably no more than 2 or 3 normal chest Xrays, or about the increased dose you'd get taking 3 airplane trips, NYC-LAX.

CT abdomen: 1,000 mrem
Airplane ride (39,000 ft.): 0.500 mrem/hour
Chest x-ray (PA): 2 mrem
Chest x-ray (lateral): 4 mrem

I would advise to OP to get a second opinion, and am unlikely to ever get another CT scan myself.
posted by trevyn at 3:19 AM on October 5, 2007 [1 favorite]

i've had a couple of abdominal CT scans done. the barium is fairly nondescript (i loathe the banana flavor, but the berry flavor is kind of innocuous). if you are allergic to anything - PARTICULARLY SHELLFISH - let them know before they put the contrast in your blood.

i had my first CT scan after having several days of abdominal pain and it turned out i had a couple of big old nasty tumors on my ovaries. one exciting surgery-after-being-admitted-from-the-ER later, i was better.

i admit to being a freak because i kind of like getting the CT scans now. 1. because it means i really still don't have cancer anymore, and 2. because i can get copies of the imagery and have excellent x-rays of my insides.

i'm pretty sure that insurance should cover the test even if the results are normal. i'd have your doctor's office call the insurance company to check, though. it's probably more effective to do that than for you to call directly.

good luck, and i hope they solve whatever's wrong.
posted by rmd1023 at 5:15 AM on October 5, 2007

Thanks, y'all. I decided to delay the CT scan until Tuesday, since I felt a lot better this morning. I called the doctor and she said if I was feeling better then, yeah, postpone it and if I feel better yet on Tuesday, go ahead and cancel it. Her office also said that they had already called BCBS and okayed the scan with them and that that approval would be good for the next 30 days. So, good all around, and I actually feel okay today.
posted by mygothlaundry at 7:27 AM on October 5, 2007

Good to hear, mygothlaundry. I was going to post back and ask if you could really press your doctor on what they thought was going on. Sometimes docs will order an abdominal CT because they simply don't know what's going on and a CT seems like the most comprehensive test. For the reasons trevyn mentioned, among other things, this is not a great approach.

If however, your doctor were to say that their "gut" told them it was appendicitis and they just couldn't prove it, then I would probably take that pretty seriously.
posted by Slarty Bartfast at 8:08 AM on October 5, 2007

My mom's blood tests all came back clean 3 times. It was her appendix - thank goodness they decided to ignore the test results and go ahead and take it out.
posted by IndigoRain at 11:17 AM on October 5, 2007

What indrogorain said. I had serious abdominal pain, but not severe enough to be appendicitis. I had an ultrasound, which was also clear for appendicitis.

I ended up having a laparoscopy and it turned out that lo and behold, my appendix had ruptured and my abdomen was filled with toxic sludge. Apparently the fact it was hiding behind my colon and an unnaturally high pain threshold masked my symptoms.

You can die from this shit, so I really would not put off ANY diagnostic procedure of this sort.
posted by DarlingBri at 11:37 AM on October 5, 2007

"...I would advise to OP to get a second opinion, and am unlikely to ever get another CT scan myself."
posted by trevyn at 6:19 AM on October 5

IANAD, and I admit my error, upthread, in comparing CT X-ray dosages to short duration cross-continental flights. That said, the additional cancer risk created by even a standard diagnostic CT abdominal scan is no more than 3 years of minimal background radiation one cannot escape receiving while living every day life, and in terms of risk/benefit for an acute medical condition, pretty minimal.

For those living at altitudes significantly higher than sea level, the additional risk profile of a single abdominal CT scan is even lower.
posted by paulsc at 2:59 PM on October 5, 2007

This analysis suggested that a single full-body CT examination in a 45-year-old adult would result in an estimated lifetime attributable cancer mortality risk of approximately 0.08%

(Full body CT is stated as 12 mSv, or about 20% more than an abdominal CT.)

So roughly a 1:1500 chance of a single abdominal CT giving you terminal cancer at some point in your life.

Compare to:

The total rate of laparoscopic complications is approximately 4-6 per 1000, and the mortality is approximately 3/100,000.

Sure, CT can be life-saving, but there are a lot of other diagnostic procedures with different risk profiles. And a lot of doctors are simply not aware of the risks of CT, also believing that the radiation doses are only a few times the normal X-ray doses. :(
posted by trevyn at 9:16 PM on October 5, 2007