Why would they schedule an abdominal CT on my 21-week pregnant daughter?
August 14, 2006 4:00 PM   Subscribe

Why in the world would they schedule an abdominal CT on my 21-week pregnant daughter?

They left a message on her phone and when she called back they'd gone for the day...the doc's office will call her tomorrow according to the message.

All my googling tells me that CT scans are not usually done on pregnant women because of the radiation used. So far they have not indicated to my daughter that there is a problem, but they have been treating her like an idiot, not telling her anything probably because she is 19 and unmarried at the moment.

So what on earth is this????

*Posted for konolia*
posted by It's Raining Florence Henderson to Health & Fitness (22 answers total) 1 user marked this as a favorite
Has she had her 20-week anatomy scan? If so, was everything ok? If not, are you sure that's not what they mean? Although the anatomy scan is an ultrasound (not a CT) it is usually done at a hospital not the OB's.
posted by The Bellman at 4:07 PM on August 14, 2006

Consider the possibility that this message has been garbled and they're calling to schedule the ultrasound Bellman suggests. The person calling your daughter to schedule may have gotten a bad message or perhaps your daughter mis-relayed it to you?

As far as being treated like an idiot, this is a great opportunity to hone her skills at demanding she be treated properly and getting information from jerks. Personally I have found that one of the most useful phrases in life is "I don't understand," even if you do. Most people will shuffle you off with BS if you'll just take it but are unwilling to just hang up on someone still asking questions.
posted by phearlez at 4:22 PM on August 14, 2006

She has had two ultrasounds already. One at about three months and one several weeks ago. The phone person said CT but it's possible that they got it wrong. Even if it is another ultrasound they are scheduling this is worrisome, as she had a doc visit just last week and they treated her like she was totally normal-not bringing up this test at all.
posted by konolia at 4:24 PM on August 14, 2006

Konolia, the only way to know the answer is to ask the question of the docs; my guess is that it's a miscommunication, but you're right, there isn't really a good reason to use an abdominal CT on a pregnant woman. (If there's a need to get a higher-resolution image of the abdomen during pregnancy, most docs feel that MRI is the way to go.) By all means, she should not go get the CT -- or do anything during the pregnancy -- for which she hasn't received an explanation and had her questions answered by her medical team.

I don't know what questions your daughter has asked of her docs and nurses, and don't want to come off sounding preachy, but I figure that this is the corollary to the above answer: if she's 19, pregnant, and her parents are the ones asking the important questions for her, then your daughter has written the exact prescription for being treated like an idiot by most medical staff members.
posted by delfuego at 4:51 PM on August 14, 2006

"great opportunity to hone her skills at demanding she be treated properly and getting information from jerks"

This is a very important skill, especially if she's going to be responsible for another human being.
posted by amtho at 4:53 PM on August 14, 2006 [1 favorite]

Sorry -- note that I have no idea if your daughter is or isn't asking questions or anything else. In the lack of that knowledge, I figured I'd tell you what I've learned is the biggest reason for medical caregivers to assume that their patients aren't interested in making decisions or knowing information -- it's that the patients haven't ever expressed an interest in their care, or are overtly deferring to others to learn the information for them.
posted by delfuego at 4:54 PM on August 14, 2006

As someone noted above, a 20-week ultrasound is very standard. It is about 30-45 minutes long and a very detailed examination of the baby's heart, brain, etc. You mention that she had an ultrasound 3 months ago and one several weeks ago. This seems to suggest that she has not had the 20 week ultrasound. Maybe that's what they are talking about and the nurse/assistant just messed up the message?
posted by Mid at 5:02 PM on August 14, 2006

Something is definitely mixed up. CT scans are not done on pregnant women without a seriously important issue at stake for which sensitive imaging is critical.

Someone's information is incomplete or this was a simple error on the part of the office.

That said, it's [possibly] disturbing that this young woman has no idea what this is in reference to. Granted, physician's often
explain things poorly, but the opposite holds true - sometimes patients retain next to nothing no matter how hard you clarify or make concrete an issue, and then tell family/spouse that no one tells them anything.

It's often the case that bringing a spouse or parent along will ensure that a physician will spend a bit more time explaining their thoughts, and this sounds like it's no exception.

And 20 week ultrasounds are not at all standard. Once an early sonogram is done to assist in confirming the due date there is no reason for another unless a clinical issue arises that would necessitate another study. Ultrasonic radiation is still not entirely established as without risk. Then there's that little issue of cost...
posted by docpops at 5:30 PM on August 14, 2006

docpops -- I'm not saying that 20 week ultrasounds are a good idea, but they are standard, at least in Chicago where my wife and and every other pregnant woman I know have had them as a matter of course in the past 1-2 years. The idea is to examine the fetus' anatomny to dectect serious birth defects. The ultrasound is given as part of the "triple test" that measures the nuchal translucency to detect Downs Syndrome, among other things.

Here's google on 20-week ultrasound.

Here's the nuchal transulency testing that is very common at 13 weeks, which is followed up at 20 weeks,
posted by Mid at 5:46 PM on August 14, 2006

Mid - I appreciate the clarification. You make a good point. In an older patient where screening for Down's is more germane I certainly agree with what you are saying. And admittedly its been a few years since I did OB. More to this case, a 'routine' US in an uncomplicated pregnancy in a nineteen year old seems odd. But then again, if it safeguards against a crippling lawsuit, then I'm not surprised.

re: your profile - I laughed at your gmail address.
posted by docpops at 5:50 PM on August 14, 2006

I think she had the regular 20 wk sonogram since she told me they said the baby did NOT have Down's after looking at it. (Apparently a normal screening from what she said.) As to communication she says they don't stay in the room long enough for her to get a question out.

I just do not understand why they would leave her a message about an appointment for a test just out of the blue like that. She isn't an idiot, if they had told her there was going to be another test at her last appointment last week, she'd have remembered.

So, whether it's an ultrasound or CT, what on earth could they be looking for -that they AREN'T telling her about???
posted by konolia at 6:12 PM on August 14, 2006

konolia - a couple of possibilities. First, the chance that it's a straightforward error. Second, any diagnostic test may raise questions about other problems. The radiologist by necessity will comment on every finding on an exam, not knowing the possible relevance. Perhaps they saw a harmless cyst on a kidney and now need to clarify what the ultrasound is alluding to, for example. I know it's hard not to let your mind race, but nothing you've said sets off alarm bells. Tomorrow am call on her behalf, or have her call and stay nearby, and ask/demand to be put through to the doctor's nurse and request explanation/clarification.
posted by docpops at 6:23 PM on August 14, 2006

I work in a high risk pregnancy clinic, but IANAmedical professional and I don't work in her clinic (most likely). I'm also not saying she's high risk, but working there we get a LOT of patient questions that aren't answered because of the sheer volume of appointments/patients (185 appointments last week, for example, at one of the two offices.)

Even though it says they're going to call tomorrow, she should take the initiative. In the morning, she should outline her questions - any of them, including asking what the clinic's usual schedule of U/S are on healthy patients, and why they've suggested another one for her at this period - if it is an U/S instead of a CT scan, which I think is bizarre and must be an error. (I'd also suggest she do this at a table with a pencil and paper so she can keep track of the conversation.)

When she calls, she should ask to speak with one of the nurses; they're often there to answer patient questions when the docs gloss over them.

Also, what I've seen in my far-too-many-years working there, the rate of lawsuits in obstetrics makes many docs err on the side of caution when it comes to relatively non-invasive tests.
posted by cobaltnine at 6:33 PM on August 14, 2006

Well, I talked to my daughter tonight and we decided I'll be going with her to the appointment. She does plan to be proactive and call in the morning (She doesn't live with me so I can't be there for the call,unfortunately.)

Thanks for all the responses...I will say that in the ultrasound pic I saw I thought the placenta looked a little low but I am not a doc so what do I know?
posted by konolia at 6:48 PM on August 14, 2006

If this is the procedure my wife went through, you get a ultrasound at 13 weeks and again at 20 weeks. Maybe this is what is going on.

docpops -- I think a lot of this is new protocol. I got that sense googling around for info. when my wife was going through it. There is a much bigger emphasis now on finding serious abnormalities in the first 20 weeks. They can do amazing stuff with sophisticated doppler ultrasound at 20 weeks, including imaging the aorta and the major organs.

There are, however, critics who say that the ultrasounds are unnecessary, consistent with what you say.

Glad you like my e-mail!
posted by Mid at 9:24 PM on August 14, 2006

I've never been a parent, though I've been an Uncle four times with two more coming in the fall, so I've heard quite a bit. Here's my anecdote.

When I was sixteen, I was at the dinner table with my parents, and I mentioned my plans for the weekend. They looked at me like I was crazy, and reminded me of the eye surgery I was having in two days.

By "reminded" I mean that they had discussed it so much between themselves that they had never realized that no one had told me about it.

First Point: Things slip through the cracks. The doctor and nurse may have discussed this, and assumed that the other had explained it to your daughter. Find out from them immediately (though they still deserve a reaming for treating your daughter the way they have.) You don't go into a procedure without knowing why. You just don't.

Second Point, and I can't believe I;m the first one to bring this up:

Congratulations, to you and your daughter.

Now go talk to the doctor, figure this out, and make sure that your grandchild is as healthy as possible.
posted by Navelgazer at 11:17 PM on August 14, 2006

I, too, am puzzled at this AskMe question - the only people who can answer are the medical professionals treating her.
posted by agregoli at 7:09 AM on August 15, 2006

Well, turns out the medical professionals must have left their message on the wrong number. Grr.

agregoli, I was simply looking for scenarios. Worried prospective grandmothers are like that.
posted by konolia at 8:37 AM on August 15, 2006

i think its good that you are going with her, but the best way to handle this situation is have her call the doctor and ask 1. is this a CT or a ultrasound, and 2. if they could please explain if this is routine or what.

then at the doctor visit request that the doctor giver her some sort of a proposed schedule of when certain tests should be administered.
posted by trishthedish at 9:17 AM on August 15, 2006

As to communication she says they don't stay in the room long enough for her to get a question out.

Traveling salesmen have known forever that getting your foot in the door so it can't be closed makes it much harder to be dismissed. Remind her that she's in an exam room they want to use for other people. Simply not leaving till they've given her the attention she deserves will work wonders.

I know I'm a crank about this but we're issued only one body so we need to be at least as concerned about our doctors and medical decisions as we are our cars. I think health insurance has insulated both sides from the transaction so much that we lose sight of the fact that patients are customers paying for a service and doctors are selling it.
posted by phearlez at 9:33 AM on August 15, 2006

Two other tidbits on how to get questions answered. Boldness is called for here. Announce at the very beginning of the consult that you have some questions you need to ask as in...

Doctor: How are you feeling ?
Patient: I'm OK but I have some questions I want to ask you before the consult is over. Can we be sure to get to them before you leave ?

Write down the questions before you arrive. A medical visit can be intimidating - and that way you won't forget.
posted by AuntLisa at 11:27 AM on August 15, 2006

AuntLisa, whenever I have to do anything medical that's my approach -- except I skip the "I'm ok but I have some questions" and just dive into my questions. I make notes & check off boxes on my list... Ask questions first, get physical later. I am first a patient with questions about my health -- that is after all why I'm in the office, I'm a warm body that needs poking/examining second, unless, y'know, I'm in the middle of a life threatening emergency...

Konolia -- I'm glad & mad on your behalf that the office left a message for the wrong patient. How worrisome! Congratulations though!
posted by susanbeeswax at 11:56 PM on August 15, 2006

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