Question: I went to see a Rhuematologist. He made it clear that he believed I had no problem. As a matter of fact he clarified his position by saying that “…your problem is psychiatric…”! Obviously that left me dumbfounded as he just wasn’t interested at all in knowing the history of my problem or anything else about me at all. He said that he would request a bone scintogram to prove to me that my problem is psychiatric. Has anyone had a bone scintogram. What do they show, how do they work and are they just a waste of time?
Answer 1: That sounds fairly outrageous. A rheumatologist is not supposed to be making psychiatric diagnoses. If it was me, I would go back to the GP, report this weird conversation, and ask for a second opinion, rather than go on with a consultant who seems determined to prove that you don’t have a problem. Let him explore his theories in his own time on somebody else’s body. I’ve had a scintogram but not a bone scintogram. I don’t know how they work specifically with bones, but the general idea is they inject a radioactive substance and then scan you to see where it goes. When I had it they were tracking the spread of cancer but I know that it’s also used for bone scans. If this rheumatologist truly believes he can show that someone has a psychiatric problem by scanning their bones, with or without assistance from radionuclides, I would say that that’s rather worrying.
Answer 2: Never heard of it… but it sounds fascinating. The dictionary lists the derivation of scintill… as to glisten or sparkle with small particles. I wonder if it’s either a radioactive injection (forget it, you ain’t putting that anywhere near my spine) or something like an MRI scan (magnetic resonance). I’m told the latter can show up a lot more spinal problems and tissue damage than normal radiographs. I’ve had a bone scan which involved drinking a radio-active substance then lying on a scanner in various positions. Not painful nor uncomfortable. Didn’t show any problems at all, but was part of the consultant’s procedure for ruling out possibilities. Had normal xrays of the hands (where my problems are) and blood tests (for underlying diabetes amongst other things). All negative, so I had an EMG which was also negative. Not sure what to do now. Reumatologist has given up and recommended I avoid the PC use(!)
Answer 3: I’ve been sitting this out a bit because, although I do know something about scintigraphy, my experience is mostly via our Vet School and referral practice and some small acquaintance with the results. As such, what I tell you will be good as far as it goes but there could well be a lot more to the story that I don’t know.
Scintigraphy is a diagnostic procedure where a radioactive element (usually Technetium) in a specific biochemical form, is injected into the patient and, after a certain time readings are taken by a special gamma radiation detector which allows a picture of various possible problems to be built up. With a cancer patient, the method can be used to find any cancer secondaries for curative or palliative treatment. It can also, in a slightly different form, be used to look at damage to bone. This is, I believe, a commonly used technique in humans (although not for what is known as “splints” which our lot is looking for).
This may be a very valuable technique. The principle it uses is that the activity is taken up into areas of tissue damage/repair. If the technique is used in such a way as to highlight the injury areas in RSI damaged muscles or whatever, this might be a big step forward. Of course it may not work that way, the test may not be used in a way that allows all possible soft and bone tissue injuries to be seen. (I don’t even know whether the testing methods for the two different sorts of problems are identical or mutually exclusive or RSI injury may simply not show up.) It does seem to me to be well worth trying.
The risks of using radioactive materials for testing, especially where the possibility of a worthwhile result is uncertain, needs considering. I am not certain what actual activity of the radioactive material will be given but I expect the form will be as Pertechnate. Depending on exactly how much is given, the dose to the patient varies between about 6 times the normal average yearly background radiation down to levels of about half the average yearly background. Personally, I’d consider that a risk worth taking but obviously it’s the person concerned who must decide.
Answer 4: Well worth trying if gone about in the right way and for the right reasons, I agree. But if used mischievously (i.e. in a deliberate attempt to “prove” that there’s nothing wrong with the patient) it could set things back. It sounded as if this rheumatologist was planning to look only at the skeleton. I don’t understand enough about the procedure to talk about it sensibly but from what you say it sounds as if it would be important for the doctor running the test to be genuinely looking for signs of damage, however it might show itself, rather than trying to prove that nothing was wrong. It all depends on the spirit in which it’s being offered, I guess. It’s all too easy to foresee the headlines: “Modern scanning techniques show no signs of physical injury from RSI“.