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Hospital scanner no good? Scans aren't scans.


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Posted

On Sunday we went for our yearly medical in Roiet. One of the tests is a kidney scan. We have this test yearly and no reported problems.

In 2019 I was having a back operation in another country and had scans before the op. which picked up a 4 cm tumor on my right kidney that was then operated on to remove the non malignant tumor. 

How can I not be aware of this tumor if I get scans yearly? This missed tumor could have been cancerous (specialist said most kidney ones are dangerous).

So I told the Thai doctor this, that maybe his machine was not good enough as it missed my tumor and how many others?

I just wanted them to realise there could be a problem.

The response from the doctor performing the scans (same Dr each year) was to say 'well there's nothing there now'. What a Richard Cranium. Of course there's nothing there now as the tumor has been removed, anyway his machine wouldn't/couldn't detect it.

So fobed off by him. Then went to the reporting doctor and she just laughed. 

I know it's pretty typical of a junior person to laugh and they don't really mean it, but in my opinion she was never going to report it.

I felt like asking for the Director, to tell them about their scanner problem but didn't.

Bit of a worry when you do an annual checkup to find potential problems before they get serious and the hospital missed crucial information.

Next yearly checkup won't be at that hospital.

 

Posted
8 hours ago, Sheryl said:

Are you sure you were having a "kidney scan"? that is not a normal part of nay checkup package.


What sort of scan? CT? MRI???? With or without contrast? IVP??

 

I cannot imagine this being part of a routine checkup and suspect you are confusing it with something else.

 

A normal checkup will include blood test of kidney function but not an sort of scan of the kidneys.

Well you could be correct. The scanner is a portable hand held machine....ultrasound I think. 

Dr does abdominal scan then you turn on your side and he uses the machine over where I think the right kidney is, then the same for the left side.

No contrast.

When the Dr was scanning my right back side, below the ribs and I was lying on my left side I asked him about the kidney tumor.  

I just looked at the report and it only said upper and lower abdominal scan so I could be very wrong as you suggest. 

So why scan the back below the ribs if not for kidney? Both doctors had enough English to tell me it wasn't a kidney scan.

So I'm a bit confused but think you are probably correct. Thanks.

 

Posted

Abdominal ultrasound focuses mainly on the liver. It could show a kidney mass but might not. (Also depends on how attentive the person doing it is). It would certainly not be described as a "kidney scan" and there is no reason to do routine scans of the kidneys.

 

Abdominal ultrasounds are not part of routine check up recommendations by any public health authority and you would not get one in the west (except possibly for a one time scan for aortic aneurysm between the ages of 65 and 75 if you are considered at risk).

 

They tend to lead to unnecessary further procedures (private hospitals here like them for exactly this reason) and thus do more harm than good.

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Posted
2 minutes ago, Sheryl said:

Abdominal ultrasound focuses mainly on the liver. It could show a kidney mass but might not. (Also depends on how attentive the person doing it is). It would certainly not be described as a "kidney scan" and there is no reason to do routine scans of the kidneys.

 

Abdominal ultrasounds are not part of routine check up recommendations by any public health authority and you would not get one in the west (except possibly for a one time scan for aortic aneurysm between the ages of 65 and 75 if you are considered at risk).

 

They tend to lead to unnecessary further procedures (private hospitals here like them for exactly this reason) and thus do more harm than good.

Great, thanks again Sheryl. The scan on my wife also showed something (but unclear, so the Dr said ) in her uterus  (I  think)  which didn't make sense as my wife just had the all clear this year from her gynecologist in Pattaya Bangkok hospital after a major operation 5 -6 years ago.

We weren't impressed this time and it did feel like rush rush rush and money making exercise. Every other time we've come for the father's day special price check up, they have food etc, but this time just rush. They said because of Covid.

We decided that we'll just go to our local hospital next year and ask for specific tests.

I also read that MRI scans sometimes do more harm than good and pick up things that may never have been a problem and lead to unnecessary operations. Now I think about it I think it was a back MRI scan that picked up the kidney tumor. As it was benign maybe it would have just stayed there with no problems, or maybe grown bigger, who knows. It was definitely a pocket hit as the surgeon used the DeVinchi Robot for the operation and not covered on my insurance. Thanks.

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Posted

One more question Sheryl please. They said they picked up a gall bladder stone on my wife's scan last year and this year it is bigger. I suppose I should believe this? 

Posted

The scan could also be used to check for bladder issues (found cancer in my case - but this was in response to symptoms -bleeding-)  As for tumors they grow over time so one scan of whatever type may not show but the next it appears.  I have scans 3 months apart for that reason and new tumor was found/removed after first removal on next scan (liver).  

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Posted
2 minutes ago, lopburi3 said:

The scan could also be used to check for bladder issues (found cancer in my case - but this was in response to symptoms -bleeding-)  As for tumors they grow over time so one scan of whatever type may not show but the next it appears.  I have scans 3 months apart for that reason and new tumor was found/removed after first removal on next scan (liver).  

Great you are on top of it mate. ????

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Posted

Very helpful information in this thread, thank you. Are annual medical check-up's the norm? I'm from UK where only the elderly receive free 'well person' tests under our National Health Service. Unfortunately, these do not test for cancer. My elderly Mother received good results when only a few weeks away from death. Even in the Medical Investigation Unit in hospital with suspected ovarian cancer, the CAT scanner didn't pick up any tumours, endoscopy (visual and biopsy) also gave clear result. Blood tests, acknowledged as the most reliable indicator, returned normal results four weeks before death, only changing at the three week point. For this reason I personally doubt the value of annual medicals. 

Posted
Just now, carlyai said:

One more question Sheryl please. They said they picked up a gall bladder stone on my wife's scan last year and this year it is bigger. I suppose I should believe this? 

Quite common to have stone/s.  I have many but so far any pain is minimal.  But operation to remove GB is not complex for most people and wife had done last year (they want to do under age 80 at hospital we use).  

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Posted
2 minutes ago, The Fugitive said:

Very helpful information in this thread, thank you. Are annual medical check-up's the norm? I'm from UK where only the elderly receive free 'well person' tests under our National Health Service. Unfortunately, these do not test for cancer. My elderly Mother received good results when only a few weeks away from death. Even in the Medical Investigation Unit in hospital with suspected ovarian cancer, the CAT scanner didn't pick up any tumours, endoscopy (visual and biopsy) also gave clear result. Blood tests, acknowledged as the most reliable indicator, returned normal results four weeks before death, only changing at the three week point. For this reason I personally doubt the value of annual medicals. 

I do think they are valuable and they have picked up both my wife and I have high cholesterol and sugar is getting up there. Wifey also has uric acid getting up there. Good reminder to lose 5kg and cut down the beer and sticky rice. ????

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Posted
2 minutes ago, carlyai said:

I do think they are valuable and they have picked up both my wife and I have high cholesterol and sugar is getting up there. Wifey also has uric acid getting up there. Good reminder to lose 5kg and cut down the beer and sticky rice. ????

@The Fugitivea friend of mine always used our local government hospital and just asks for the tests he wants. He pays B50 for the doctor and I think his bill is around B200. I had a CAT scan there and think it was B7000 with contrast, to see if my back operation cage inserted between the vetabrae had moved. Local government hospital good value. 

You can go to your local government place and get an ID card. It's like the Thai ID card and once you register at the hospital with the card it's all fairly easy. There's a place at the hospital with a sign that says for foreigners, so maybe the foreigner price where you pay, but with the ID card you are just treated the same as Thais. I don't know if foreigners are charged a different price or not.

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Posted
2 hours ago, carlyai said:

One more question Sheryl please. They said they picked up a gall bladder stone on my wife's scan last year and this year it is bigger. I suppose I should believe this? 

Yes, gallstones show clearly on ultrasound, in fact ultrasound is the best means of identfying them. 

 

There is about a 20% chance of this stone causing her problems sometime over the coming 20 years. .Potentially serious  if it blocks the common bile duct. But odds are against this.

 

Most physicians would recommend doing nothing unless she becomes symptomatic.

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Posted
2 hours ago, carlyai said:

I do think they are valuable and they have picked up both my wife and I have high cholesterol and sugar is getting up there. Wifey also has uric acid getting up there. Good reminder to lose 5kg and cut down the beer and sticky rice. ????

I would agree! Many thanks.

Posted
2 hours ago, carlyai said:

@The Fugitivea friend of mine always used our local government hospital and just asks for the tests he wants. He pays B50 for the doctor and I think his bill is around B200. I had a CAT scan there and think it was B7000 with contrast, to see if my back operation cage inserted between the vetabrae had moved. Local government hospital good value. 

You can go to your local government place and get an ID card. It's like the Thai ID card and once you register at the hospital with the card it's all fairly easy. There's a place at the hospital with a sign that says for foreigners, so maybe the foreigner price where you pay, but with the ID card you are just treated the same as Thais. I don't know if foreigners are charged a different price or not.

Again, many thanks! Good idea and certainly economical. I've been twice to Government hospital A/E's, once to local hospital for what turned out to be food poisoning and to Provincial hospital for a collapse due to low blood glucose. Bills were only approx. 200 baht for one and 800 baht for the other. Excellent treatment in both cases.    

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Posted
19 minutes ago, Sheryl said:

 

There are conditions annual check-ups will definitely help pick up, including at early stages when still preventable. These most notably include diabetes and  dyslipedemias (a risk factor for heart disease and stroke), and it would be foolish to refrain from such checkups just because they do not screen for all diseases. There are also tests that can help detect coronary artery disease, such as Exercise Stress Test. Not 100% but will detect it about 85% of the time and is non invasive and not too expensive.

 

Many cancers do not as yet have a viable screening tests. A few do. Others have tests but ones that are complicated or invasive so not recommended for everyone just high risk groups.

 

Cervical cancer: easily detected by thin prep/pap smear, strongly recommended  for all women up to about age 65.

 

Colon cancer: detectable by colonoscopy (gold standard) and to a lesser extent by stool tests. recommended for adults over age 50 (earlier if risk factors like polyps or family history) but only every 5-10 years, it is an invasive procedure.

 

Breast cancer: mammogram will detect most but not all cancers. Recommended every 1-2 years for women over age 45 (earlier if risk factors). Manual breast exams also recommended but less effective.

 

Prostate cancer: manual prostate exam recommended annually for men over age 55 (earlier if risk factors). PSA (blood test) is also of use but somewhat controversial as non-cancerous conditions can also cause elevations. Worth doing IMO provided patient and doctor are sensible in interpreting the results.

 

Lung cancer: can often be detected early through a special low dose CT scan. Expensive and involves contrast material which carries some risks. Currently recommended only for  people aged 55 to 74 years of age with at least a 30 pack-year smoking history, who still smoke or quit smoking less than 15 years ago. People meeting that criteria should have one at 3 year intervals.

 

Skin cancer: a visual inspection of the skin by a doctor experienced in detection of skin cancers will detect most cancers, but there are very, very few such in Thailand.

 

There is currently no effective screening tool for ovarian cancer, nor for many other cancers (pancreatic etc).

 

Some private Thai hospitals tout supposed blood tests for cancer such as AFP, CEA etc ("tumor markers"). These are elevated in some cancers (and often useful in monitoring response to cancer treatment) but are very nonspecific and are also elevated in many non-cancerous conditions and sometimes for no evident reason; they can also be negative in early cancers.  They are not recommended for mass screening purposes by any public health authority. They lead to a lot of unnecessary invasive tests so can in fact do more harm than good.

 

Regular check ups are important but it needs to be well understood what tests are indicated and what they can and cannot detect. At Thai private hospitals in particular need to be aware of tests that are not in fact recommended for mass screening, and that includes all sorts of scans and "blood tests for cancer" etc. Not only may these lead to unnecessary invasive tests with potential risks, they can also lead to a false sense of confidence. Much as anyone would like to be able to be sure they  do not have cancer of any type, that is impossible to determine. Only the cancers listed above can be screened for,  and even then, the screening will nto catch 100% of them.

 

 

 

 

 

 

 

 

Thanks Sheryl! So much information here, I'll save it to my cloud for posterity! Medical science is never going to be perfect and cover everything. I agree it does makes sense to be checked over and diagnose things earlier rather than later where possible. 18 months ago Thai Mrs had a large cyst cut out of her leg as an out-patient at Provincial hospital. Went for a follow-up and they 'signed her off'. More recently she suffered leg, knee pain and numbness. GP at local hospital saw her swollen knees and prescribed tablets as did two private high street specialist clinics. Now she has a large bulge in her leg. Doctor at Provincial hospital found four others also. He didn't say what they are but she is now awaiting MRI scan. Keeping fingers crossed.

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Posted
49 minutes ago, ExpatOilWorker said:

I had the iHealthy 40+ (10,900 baht) done at Mission Hospital and it included the upper and lower abdomen scan.

I feel the procedure, examination,  equipment and reporting was excellent. 

 

https://www.mission-hospital.org/en/packages.html

 

 

20201208_124608.jpg

We didn't get a report like that. Just good or bad mainly, but it is a Father's Day special for B2500 each stopped down from B5000. Spose you get what you pay for. Yours is a nice report.  ????

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