Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
I'd like to discuss what to expect in each kind of
examination that a patient may undergo.
Regular X rays do not hurt, of course. Shielding is
often necessary, which is a heavy lead robe worn over areas
of the body that could be affected by radiation. Most X rays
give off little radiation, but shielding is always a good
idea.
In pregnancy, one must weigh the special risks. Missing a
minor fracture of the ankle may not justify an X ray. Let me
remind women that leaving a child alone in a room for X rays
while you stand outside because you are pregnant may be very
stressful for a child, as the machines are big and scary.
Consider having your husband go instead, or bring an older
child/friend and have them wear a shield.
Barium swallows examine the upper digestive system,
and require the swallowing of a bad tasting liquid and taking
serial x-rays over a few hours. Constipation is common
afterwards. IVPs examine the urinary tract after the
injection of a dye which is excreted in the urine. This exam
also takes a few hours. A barium enema is extremely
uncomfortable. You may want to ask your physician if
colonoscopy is possible instead. It too is
uncomfortable, but you are under sedation for it and it
reveals a lot more information.
Ultrasounds are painless and may even tickle. They are
routine in pregnancy now, and are the best test for
gallstones. Most people complain that the gel used to help
transmit the sound waves is very cold. Ultrasounds are now
done internally for both men and women. They reveal a lot of
information. In nonpregnant women, abdominal ultrasounds of
the lower abdomen require a full bladder, which is also
uncomfortable.
Cat Scanning, or CT is a painless test as well, but
the equipment requires a cold room, so be prepared. Today's
CT scans are a lot faster, so the actual time spent in the
suite is less than in the past.
MRIs are also painless, but the early ones were
extremely claustrophobic: patients had to stay still with
their head in a small box for a long time. The MRIs in the US
have improved on that, but I do not know if in Israel they
have.
All nuclear medicine scans require the injection of a
radioactive material, so that does hurt. They also require
that the patient be still for a long time. Few scans are done
quickly. Be aware.
Bronchoscopy looks at the breathing tubes,
gastroscopy looks at the upper digestive tract and
colonoscopy looks at the lower tract. They are all a
little uncomfortable. The first two are performed with local
numbing of the throat, whereas the last is with sedation that
makes you forget what happened.
Cyroscopy examines the bladder, and hystoscopy
examines the uterus. These require a greater amount of
sedation and are usually done in the operating room.
Laparascopy is an interesting test. It is done by
making a small incision below the belly button, and inserting
a lot of air in the belly. Then a scope is put in and the
whole abdomen can be looked at for problems. This can even
save a person from an operation for appendicitis. Amazing to
me. What do you think? Write me in care of the Yated.
