To Dye or Not

Last week, I underwent a three-month scan for cancer. I am still cancer free, so let’s get that out of the way. I’m so cancer free that I started thinking about those with kidney cancer who have scans. That’s when I started asking questions about this procedure that I’ve already undergone what seems like a million times. My questions, while answered by the technicians, of course led me to other questions. Here are the answers. 

Let’s start at the beginning. Do we use CT or CAT Scan when referring to this kind of test? According to Cincinnati Children’s Hospital Medical Center’s Blog at https://bit.ly/3lKrkjP:  

“… CAT and CT scans both mean the same type of diagnostic examination. CAT was used earlier in its history, while CT is the recent up-to-date term for convenience sake. The term CT stands for computed tomography and the term CAT stands for computed axial tomography or computerized axial tomography scan.” 

Huh? I get ‘computed,’ but what’s ‘tomography’? On to my favorite dictionary of all time. You guessed it; The Merriam-Webster Dictionary at https://www.merriam-webster.com/dictionary/tomography tells us, it’s: 

“a method of producing a three-dimensional image of the internal structures of a solid object (such as the human body or the earth) by the observation and recording of the differences in the effects on the passage of waves of energy impinging on those structures” 

Ah, that makes sense. Now what about this iodine dye that we, as Chronic Kidney Disease patients, are not supposed to have? I went to Inside Radiology at https://www.insideradiology.com.au/iodine-containing-contrast-medium/ for information. 

“Iodine-containing contrast medium (ICCM), sometimes called contrast or contrast medium, is a chemical substance used in medical X-ray imaging [Gail here: CT is a sort of X-ray.]. When injected into the body, ICCM shows what is happening inside the hollow parts of the body (like blood vessels, the stomach, bowel or even the fluid around the spinal cord) on X-ray images or pictures. When injected into a blood vessel, which can be either an artery or a vein, it not only shows the inside of the blood vessel, but it can give information about how the organs supplied by that blood vessel are working. Good examples of this are the kidneys, brain and lungs.” 

I still have my port from chemotherapy, so that was used to inject the iodine dye. Reminder, 

“A chemo port is a small, implantable reservoir with a thin silicone tube that attaches to a vein. The main advantage of this vein-access device is that chemotherapy medications can be delivered directly into the port rather than a vein, eliminating the need for needle sticks.” 

Thank you, Moffit Cancer Center, at https://moffitt.org/treatments/chemotherapy/what-is-a-chemo-port/ for this information. It’s pretty clear ports can also be used for the dye, blood draws, and infusions of any kind. For example, I’m receiving iron infusion once a week via my port. 

I know the big question here is why am I having contrast dye when it’s not recommended for CKD patients. Let’s take a closer look at that warning.

“’The historical fears of kidney injury from contrast-enhanced CT have led to unmeasured harms related to diagnostic error and diagnostic,’ explained lead author Matthew S. Davenport, MD, associate professor of radiology and urology at the University of Michigan in Ann Arbor, Michigan. ‘Modern data clarify that this perceived risk has been overstated….’” 

The above statement is from U.S. Pharmacist at https://www.uspharmacist.com/article/risk-of-contrast-media-in-reduced-kidney-function-patients-overstated

I’m comfortable with iodine contrast. First, it was clear that cancer took precedence over my kidney health, but now I’m not worried about it because of the overstatements. 

After the CT, saline was infused into my port. Wolf Medical Supply at https://bit.ly/3gjx8Q6 did a great job of explaining what this is and how it’s preformed in layman’s terms: 

“A saline flush is used to help prevent IV catheters from becoming blocked and to help remove any medication that may be left at the catheter site. 

A saline flush is a sterile mix of salt and water that is compatible with your body’s fluids and tissues. Typically, the healthcare provider will fill a syringe using a bottle of normal saline solution or use a prefilled flush syringe that’s been prepared under sterile conditions. 

To flush the IV, first, clean the IV port or hub, then connect an IV saline flush syringe to the port, slowly pull back on the syringe plunger, inject the saline solution into the IV line, and then start the medication drip. Before beginning another infusion, your provider will flush the line again.” 

We’re not done yet, though. Next came a heparin flush. Does the word ‘heparin’ sound familiar?  According to Drugs.com at https://bit.ly/3qvmGcW,   

“Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. Heparin is used to treat and prevent blood clots caused by certain medical conditions or medical procedures. It is also used before surgery to reduce the risk of blood clots.” 

I didn’t understand why I needed heparin after a CT. WebMD at https://bit.ly/3mUeCjK explained: 

“This medication is used to keep IV catheters open and flowing freely. Heparin helps to keep blood flowing smoothly and from clotting in the catheter by making a certain natural substance in your body (anti-clotting protein) work better….” 

While I understood the CT process now, and hope that you do, too, there are warnings in place. For example,  

“Patients with kidney failure or other kidney problems should notify their doctor. In some cases, the contrast media can cause kidney failure, especially in patients with underlying kidney problems or dehydration. Patients taking the diabetes medication metformin (Glucophage), or its derivatives, who receive contrast are at increased risk of developing a condition called metabolic acidosis, or an unsafe change in blood pH, and the drug may be halted for 48 hours after the procedure.” 

The above is also from WebMD, but this time at https://www.webmd.com/drugs/2/drug-60428/heparin-lock-intravenous/details.  

I take the warning to mean speak with your nephrologist first. Although, your case may be like mine was: cancer first, then kidneys, especially if it’s kidney cancer. But we always speak with our nephrologists first, don’t we?  

Until next week, 

Keep living your life!

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