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Old 02-11-2008, 08:50 PM   #1
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What can I do if a radiologist can't/won't do a biopsy?

Hello! Two summers ago I developed severe pain in my upper right leg and I eventually became unable to walk without help. A CT and MRI showed I had a lesion in the medullar canal of my right femur. The MRI said it was worrisome for myeloma. My doctor felt it was one of two things; either a brown tumor or myeloma, but felt it was probably a brown tumor. He sent me on to the university to see a specialist for a second opinion. That doctor also felt it was a brown tumor, watch should be kept on it. Strangely, after many months the pain in my leg got better (lesion is still there). This last November I saw a neurologist about some ongoing chronic pain in my hips, legs and feet. The neurologist ordered some MRI's of my spine. I brought all my MRI films with me on my follow-up with the neurologist. When I began talking with him I quickly realized this neurologist didn’t remember me and I had to refresh his memory of my case and I gave him all my films. He very quickly slapped about 25 (?) films up on the wall and as fast as that took, he then turned to me and said there was nothing wrong that he could see. I was very surprised as I felt he never took any time to read my results or to view my films! I mentally made plans to get a second opinion and I politely asked him if I could have copies of my MRI results, which he gave me. A couple days later I read my results and was further surprised that they said I had more lesions on T6, T12 and L1 and L2 part of my spine, also worrisome for myeloma. I went back to my original doctor and gave the copies to him, asking him if this is something I should be concerned about. He said “Yes,” and sent me back to the university specialist to get a biopsy. That specialist said he didn’t want to do a biopsy because going into the femur with a needle could cause the femur to fracture. Any biopsies would have to be taken from the spine. Back to my original doctor I went who then referred me to an oncologist in my area. This oncologist began treating me for chronic anemia (I’ve had to have two sets of iron infusions within the last year and am now getting more), and ordered a bone marrow test and a spinal biopsy to be done. Last month I finally got the bone marrow test which showed everything normal except for the anemia. The spinal biopsy was never done because the radiologist “Didn’t feel comfortable doing it.” Months have passed and I still don’t have a diagnosis yet. On my last follow-up with the oncologist he was almost rude to me, being very short whenever I tried to ask any questions, actually cutting me off. It was one of the most upsetting doctor visits I’ve ever had in my life. I was incredulous that he was going to do “nothing”. I asked him if I still needed a spinal biopsy done, and he said, “Yes.” Then I asked him if I was going to get one and he gave me an emphatic “No!” I asked “Why?” and he said, “Because the radiologist doesn’t feel comfortable doing it!” I asked if I shouldn’t go to someone else who would feel comfortable, or who could do it? He said he didn’t know of any such person! Reluctantly, he finally said he would go ahead and put another order forth [to the same radiologist] to do the biopsy. I also expressed my deep annoyance that this radiologist office wouldn’t even call me for weeks to let me know it wasn’t going to be done! The oncologist said, “That’s because he called me instead!” Well it’s been a couple weeks now since this second biopsy has been ordered, and I still haven’t received a call from anyone. I feel very discouraged and don’t know the next correct step to take. I also asked the oncologist if it was possible to have myeloma even if the bone marrow test was normal and he said yes. I feel so upset with the oncologist that I don’t want to return to him, since he’s so difficult to communicate with. I’m having problems of even getting a new doctor, since I’m already under the care of the present one. I ran into a like problem trying to get an appointment to see a urologist. They’re all booked many months out. I’ve developed bladder incontinence in the last few months, and have no control. The last time I saw a urologist (his nurse actually) was 8 years ago. One urologist’s office that could get me in quickly wouldn’t take me because I’m a patient of the urologist I saw 8 years ago! At what point is one considered a new patient? I have many other complex medical problems, have been in and out of the hospital due to serious infections, and lack energy to constantly fight my way through these brick walls I keep hitting. I wonder if I’m being overly worried unnecessarily? How can I go about getting a diagnosis in a timely matter? Is getting a spinal biopsy as painful as a bone marrow test? I don’t feel I can go through that kind of pain again and as much as I need the biopsy done, I’m absolutely terrified of it. I’m also experiencing intolerable pain in my back. Could these lesions be causing this pain? I can’t imagine going through the rest of my life with this! Any advice you can give, I would humbly appreciate it. Thank you so much in advance.

 
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Old 02-12-2008, 01:38 PM   #2
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Re: What can I do if a radiologist can't/won't do a biopsy?

To my knowledge, a radiologist doesn't perform the biopsy - they just read films (xrays, ct, mri). An orthopedic oncologist (someone to look for) would be the one to do the actual biopsy (surgery) and a pathologist would do the diagnosis of the biopsy.
I would definitely be looking for another doctor in possibly another town.
It took me over 6 years to get my final diagnosis, but at least I had an initial diagnosis and a biopsy from my femur (that would shatter if hit wrong) within a week after seeing an orthopedic surgeon. Ended up at NIH in Maryland.
Wish you the best!

 
Old 02-13-2008, 03:22 AM   #3
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Re: What can I do if a radiologist can't/won't do a biopsy?

Hello Hrtofluv!
Thank you for responding to my post. I thought the same thing as you did until I was told differently. A couple days ago I called an orthopedic surgeons (specialist) office to see if I could get an appointment to see him. I had a lengthy conversation with his office nurse, explaining what I'd been through and what's been going on. She explained back that the surgeon did not do any biopsies - he has a radiologist do them! The surgeon only handles doing surgeries. I don't know if this is a specialized field for a radiologist or what, but I think it's very strange. Personally, I would feel far better having a surgeon do a spinal biopsy on me. Anyway, I guess I go from oncologist to a radiologist, then on to a surgeon, if needed. At least it's this way here where I live. Yesterday I was finally....finally...able to get an appointment with a different oncologist. I'll have to wait until the end of the month before I can get in to see him though, but that's ok. !OMG - 6 years?! That's awful! Seems like you've been on a very long, rough road. I certainly hope things are going far better for you. I sincerely wish you all the best of luck. Kindest Regards - Annie

 
Old 02-13-2008, 09:04 AM   #4
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Re: What can I do if a radiologist can't/won't do a biopsy?

Well, guess you learn something new everyday. Glad to hear you're getting a second opinion. Let me know how it turns out next month.

 
Old 02-13-2008, 12:13 PM   #5
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Re: What can I do if a radiologist can't/won't do a biopsy?

Hi Hrtofluv!
I had an appointment today with one of my docs. I asked him why a radiologist would be doing a biopsy instead of a surgeon. He said it depended on the type of biopsy. If it's to be a closed biopsy, taken by a needle aspiration (while being guided on a screen where to go), then it was a radiologist that did this. If it was an open biopsy, where the patient had to actually be cut open, then a surgeon did the biopsy. So now I guess I understand. Yes, I certainly will let you know how things turn out! Thanks again! - Annie

 
Old 03-21-2008, 08:29 PM   #6
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Re: What can I do if a radiologist can't/won't do a biopsy?

Hi, not sure if I'll be of help here, but I'm a student in x-ray school to be a tech (not a radiologist) but I am around radiologists regularly, and have seen a lot of spinal procedures being performed, so perhaps I can add a little insight here...

Did the radiologist give you an exact reason why he wouldn't do the procedure?? I have seen them before refuse to do a procedure because there is a high risk of injury to the patient. If your vertabrae are very compressed or mishapen or if you have scoliosis or twisted vertabrae or really just anything out of the ordinary, it may be really difficult for the radiologist to be able to get in there with a needle without causing harm to you (by hitting and/or damaging your spinal cord). This would be the only reason I could think the radiologist wouldn't do the procedure. That or he is just not a good doctor. He very well could be a guy who is not well trained and just too scared to do the procedure because of his lack of experience.

I hope this helps you at least a little bit, and I wish you the best of luck with everything. God bless!

 
Old 03-23-2008, 04:40 PM   #7
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Smile Re: What can I do if a radiologist can't/won't do a biopsy?

Hello! Thank you for responding - it does help me to understand somewhat. All I know is that I was originally scheduled by my oncologist to have a spinal biopsy done. The radiologist (or his office) was to call me at home to schedule an appointment for me. Weeks went by, and I didn't receive any call for an appointment. I got the ongoing excuse from the receptionist that the radiologist wanted to review all my films first, so they were waiting for them to come via the mail. I had another follow-up office visit with the oncologist in the meantime and I mentioned I was never able to get my biopsy done. He told me the radiologist didn't call me because he phoned him[the oncologist] instead and told him "He didn't feel comfortable doing the biopsy" on me. That was the only reason I ever got (from the oncologist). I expressed my annoyance to the oncologist about not getting a phone call back from the radiologist or anyone else after my repeated calls to their office. After a kind of a go-around discussion with the oncologist, he said he would reorder the biopsy, since by now the radiologist should've had time to review my films, which I'm assuming he did. As of today I have received no call from anyone. It was very clear that day the oncologist had no intention of doing anything else for me, even though he admitted I did need to get this biopsy done. When I tried to ask him questions about my situation, he was extremely abrupt with me, actually cutting me off before I could even finish my questions! I have to say that day was one of the worst office visits I've ever had with a doctor. I will never return to him. I finally went back to the University Medical Center where I live and went to a bone specialist I'd seen a couple years ago, taking all my films and medical notes. He is now referring me on to an orthopedic doc who can help me. I've had to be my own advocate in all this and it has taken me many weeks, much time and effort to get any help. I haven't quite figured out why this type of quality care has begun to take place. I wonder if it's just me or is it happening to others? Or is it perhaps because of the type of insurance I have? (Medicare). Anyway, I think you are probably right in the reason why the radiologist wouldn't do my biopsy as I do have some of the spinal problems you mentioned. I don't know a lot about my problem, as I couldn't get any questions answered. I'm in great pain constantly now. I only wish the doctors and/or the medical staff would respect the patients enough to at least call them and give them a response if not a reason. It's terribly upsetting to be treated like this, especially when you feel so miserable. I certainly hope when I do get the results of my biopsy, it will be positive news after all this time has passed. This has been my main concern. Thanks so much again for taking the time to respond. It does help. I was really exasperated that day when I posted my question. Kindest Regards ~ Annie

 
Old 03-24-2008, 07:09 AM   #8
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Re: What can I do if a radiologist can't/won't do a biopsy?

Hey Annie!
Glad to hear you are being proactive in getting the help you need.
I had to do the same thing. I always took a notebook with me and wrote notes - asking the doctor to spell things that I didn't understand. And I always had questions written down to ask (things I would think of days before I would see him). So, it got to the point he would take my notebook and write the answers down as he verbally told me.
I have a very rare benign bone tumor disease and it took several doctors to finally get a diagnosis. I changed doctors 3 times up front because the first one was too old (ready to retire) and wanted to take the wait and see approach. The second was not on my insurance plan, but I had gotten in with him to review my films because the office manager went to my church and then he told me the best doctor to see (who had worked with PFD before). That was my original diagnosis. So I was with him for my first 2 surgeries.
Then I ended up at NIH for a study of PFD and come to find out, I don't have it - I have something more rare. I went back to NIH for several years (although it was a very long trip) which was excrutiating after having to return home after surgery on my arm once. I did find some closer ortho. oncologists, but the first one had a horrible bedside manner. So, I am currently seeing on in Alabama. I only go about once a year, unless I am having a terrible time.
Not having that radiologist perform the biopsy is probably a good thing - he might have screwed something up.
But this is the reason for my post today - I was my own advocate at 25 years old and spoke up, even though my mom was there - I was in charge. YOU have to be your advocate because noone, not even doctors, are going to be! Speak up and don't allow them to talk down to you! YOU are a human being that deserves the respect and attention that everyone in the US is entitled to! Regardless of insurance or not.
Go into the doctor office and say I am woman - hear me roar!
Keep me posted on how things turn out!

 
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