I just had a CT…

I just had a CT scan of my neck.  To look at my right submandibular gland. If you’re unfamiliar with that, it’s one of the salivary glands.  And CT stands for Computed Tomography.  We used to call them CAT scans (some people still do), but the ‘A’ didn’t stand for anything, and it always reminds me of that dumb veterinary joke that goes something like, ‘A veterinarian tells a dog owner that he is not sure what his wrong with his dog.  Then a cat enters the room.  The client asks why the cat is there, and the veterinarian says that he is doing a cat scan.”  Ha, ha?  Maybe I have the joke totally wrong.  It doesn’t seem right.  But it embodies the spirit of the joke, so it will have to do.

The CT scan came about because I had two episodes of salivary gland swelling caused by stones in  the duct from the salivary gland, occluding the ducts and preventing the normal flow of saliva.  Both times, I was kind of dehydrated (I’d been in hot weather, hadn’t had enough water, exercised… I’m not very good at drinking water unless I feel really thirsty, and by the time someone feels thirsty, they are already at the point of dehydration.)  So there was some reason for these salivary duct stones, but most people don’t get them when they’re dehydrated.  I’m just special.  Anyway, the scan was to look for stones in the actual gland, so that future episodes can be predicted and, hopefully, prevented.  Not a big deal.  My doctor is not looking for a malignant tumor or some other dire situation.  But for some reason, the scan still unnerved me.  

Even as a physician, going into medical settings as a patient is highly charged.  Maybe partly because I have had more serious medical problems in the past and I live with a feeling of a little black cloud over my head.  Or maybe because these settings are just very serious, and many people are there with higher stakes than I have this time.

I have to say that everyone who has cared for me this time, save the first otolaryngologist (ENT doctor) I consulted, was wonderful.  It was unpleasant having the stone, because it caused pain, a big lump under my tongue, swelling under my jaw when I ate, and difficulty eating.  The first doctor, the one who treated me the first time and was fine (but I was already on the way to getting better then), blew me off this time.  He said that he didn’t see much of a problem and I should just hydrate and put warm soaks on my salivary gland.  But I’d told him that the lump in my mouth had been there for days, and wasn’t budging, despite vigorous hydration, sucking on lemon candy (which makes saliva flow) and taking antibiotics, which had been prescribed by phone on the weekend when it started and I was in a lot of pain.  Here’s the problem:  I did not feel at all listened to, nor did I feel that he’d done a thorough exam.  The lump was visible and palpable to me and to my husband.  It hurt.  And he claimed he ‘didn’t really see much.’  I have a strong belief that we must listen to our patients, really listen. Most patients who feel there is something wrong are telling you something important.  It only made it worse that I’d experienced this before, so I knew the territory, and I am a physician, so I know the signs and symptoms of various things from reliable sources.  Still, he was dismissive.

In a previous life, I might have listened to him and kept suffering.  But I knew I was right on this one. So I asked my husband for a referral in his hospital system, and he helped me get a prompt appointment.  This difference between the doctor visits was night and day.  The new consultant immediately saw and felt the lump, and told me that I was right- if it hadn’t moved or changed in 5 days, it wasn’t going to.  So he removed it in his office, virtually painlessly, by making a tiny incision in my submandibular duct.  I had immediate relief, despite a little discomfort at the incision once the lidocaine wore off.  And he suggested that, given the history of two episodes of stones, I should get this scan.  Not an emergency.  Just to dot the i’s and cross the t’s.  He was kind, respectful, even kind of fun to be around.  Everything I would aspire to be with my patients.

I delayed the scan a little.  Not to be non-compliant.  Just because I had to work through my own pros and cons of such a test.  Pros:  I’ll know better how to prevent further episodes.  I’ll know there’s nothing more wrong.  It is a painless test.  Cons:  it’s use of medical resources that I need less than other people.  I will irrationally worry for a day or so, until I get results, that I have a tumor or some other significant problem.  I needed contrast dye, which gives an unpleasant flushing sensation.  It’s radiation (not that I’ve had that much cumulative radiation in my life that it’s a concern, but it’s still radiation.)  Yes, actually more cons than pros, but ultimately I decided that I trust my doctor enough to do what he thinks is right.  

When I arrived at radiology this morning, the receptionist was as lovely as could be.  The check-in process was seamless. I only waited 10 minutes after I checked in, not long enough to get all riled up about the other people there who might be getting tests to look for ovarian cancer or serious heart or lung disease.  The tech who put in my IV for contrast and did the scan was sweet, reassuring, and technically excellent.  I was out of there in less than 40 minutes.  NO BIG DEAL.

Now I’ll wait for results.  I will probably irrationally wonder off and on if there is some horrible thing wrong with me.  I know that, no matter what reassurance I give patients when I send them for tests, many anticipate the worst.  If I can worry about something this non-threatening, I can only imagine how much they worry.  It reminds me once again to contact them as soon as possible once I get a test result.  Worrying is a legitimate form of suffering, and if I have the antidote, I better hand it out as quickly as I can. 

-RK

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~ by drrozkaplan on January 26, 2012.

One Response to “I just had a CT…”

  1. I’m voting for NO BIG DEAL
    Grateful for my amazing friend and a doctors’ doctor.

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