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Help! Is there anyone here who can read Xrays?

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  • Help! Is there anyone here who can read Xrays?

    So I had a fall off my Hanoverian two months ago and Fractured my L2 vertebrae (see this thread

    Long story short - I took my follow up xrays today and I'm pretty nervous about what I can see. From my CT scan from the day I broke it I could hardly see the fracture at all, it was very small, just a sliver broken off from the bone.
    This is what my back looks like now Here
    (sorry the pic is bad)

    I don't get to hear from my doctor for a month (soonest appointment I could get) and I'm just really paranoid that maybe something is wrong

    I'm wondering if maybe I should call my neurosurgeon and see if I can get in before, or maybe see a different doctor that could get me in?

    any help is appreciated. Sorry if this is a bad place to post... I don't really know where else to look to advice other than my doctor who is incredibly hard to get a hold of
    Eventers of the West
    A Facebook group I created for Eventers in the West Region of the U.S.
    Remy - My OTTB Gelding! Love him to pieces!

  • #2
    Okay--first of all, it is not unusual for fractures to be more apparent after a couple weeks. The calcification process sort of "outlines" things sometimes. I've even had breaks that were NOT visible on radiographs directly following the indecent, but were quite obvious a few weeks later, well into the healing process. That, in itself, was not concerning.

    But looking at your film, there seems to be a pretty impressive displacement or an excessive calcification thing going on, and I understand why you're worried. I would be too. I would also want a doctor to see those films NOW, and not in a month.

    Even though you're not able to get an appointment, can your doc just review the new films? I would think he'd want to see, and get you in sooner if there is something to be worried about. If he's not able to even look at the films for another four weeks, I would see someone else who can.

    (Is there also some lipping on the bottom of the vertebrae two above the fracture?)

    Disclaimers: I am not a doctor, and I did not stay in a Holiday Inn Express last night.

    Comment


    • #3
      Try to get a hold of the radiologist's report, for both old and new X-rays, to see what his evaluation was. You should be able to get both sets of X-rays and the reports sent to your regular doctor, with whom you can discuss the findings. If your regular doctor sees the reports, he/she will be able to tell you if you need immediate attention. Hope that helps. The good news is, at least it doesn't look as though you have compressed discs.

      Comment


      • #4
        I agree about asking to see the report and I'd keep pushing for a doctor's appointment as soon as possible. I just caution you, I read my report and felt very comforted because the only adjective to describe issues that I saw was "mild" so I was all happy. When I saw the surgeon he said "on a scale of 1 to 10 of backs he sees with 10 being the worst, yours is an 8 and could easily become a ten if you bend to pick up a paper clip wrong". Talk about being shocked. So I am crying hysterically as they say I have to have a spinal fusion in a few days and the nurse practitioner says, "you really didn't know? Didn't you see your reports?"

        I promise, I am not a stupid person.

        Sooo, moral of the story, if you aren't a doctor specializing spines even reading the reports doesn't promise a clear understanding. Get a doc to review your results with you asap.

        Comment


        • #5
          Leaving a patient out in the wind with Xrays & no explanations...not good! I would fire my vet for this. Def. try to get radiologists report & if doc has no sooner appts she/he should at least be able to do a short phone discussion?

          I guess if it was dire they would get you in sooner?


          Sorry you are going through this. Hang in there!

          Comment

          • Original Poster

            #6
            Thanks for the help guys! They reviewed my CT but apparently they need to see my xray (pictured in OP) and so I am taking it to them tomorrow. I should get a call to see what is going on. I'll post an update when I find out!
            Eventers of the West
            A Facebook group I created for Eventers in the West Region of the U.S.
            Remy - My OTTB Gelding! Love him to pieces!

            Comment


            • #7
              disclaimers: not a doctor, don't know anything about films, but can i just say that i think it's absolutely [edit] OUTRAGEOUS that YOU, the *patient*, are having to chase this down??

              but yeah, if your doctor won't get you in soon, then find another doctor. i mean, this is your *spine* not your pinky finger or something.

              -rant over-
              Last edited by Moderator 1; Nov. 11, 2012, 09:45 PM. Reason: language
              ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
              Today I will be happier than a bird with a french fry.

              Comment


              • #8
                Originally posted by charismaryllis View Post
                disclaimers: not a doctor, don't know anything about films, but can i just say that i think it's absolutely [edit] OUTRAGEOUS that YOU, the *patient*, are having to chase this down??

                but yeah, if your doctor won't get you in soon, then find another doctor. i mean, this is your *spine* not your pinky finger or something.

                -rant over-
                Unfortunately, it can take several days to for a referring doctor (the one who sees the patient) to receive and review reports and images from the radiologist who is providing the image interpretation. They often work for different entities, but even where both physicians are members of the same group or employed by a hospital, the communications mechanisms can mean delays of a day or two.

                That said, if there is a significant finding on the X-rays (or MRI, CT, etc) the normal protocol is for the radiologist to not only provide a report, but to pick up a phone and speak to the referring physician (or a member of that doctor's staff) to communicate that information so the patient's situation can be addressed right away.

                Put another way, if the radiologist saw something really concerning on your film, he'd almost certainly have called your doctor, who would arrange to see you quite quickly.

                Of course, sometimes things do slip through the cracks, unfortunately. It is unusual, but it does happen; medicine is practiced by humans, who occasionally make mistakes. Sometimes systems break down; files get lost in transmission, faxes don't work, etc. So it is always a good idea to request a copy of your medical records anytime you have an exam or procedure that is more than the typical wellness scenario. By law, physicians and hospitals MUST provide you with that information; normally a simple request to "Medical Records" is sufficient. There may be a nominal charge for copies. If you have any sort of imaging done, you can also ask for a copy of the films on disc, but be aware that the viewers which are typically automatically included to allow the image to be opened and viewed will often not provide the same image quality as that viewed by the radiologist, who will have a diagnostic (2-3MP greyscale or better) monitor, and who will view an uncompressed (read: VERY large) file on their clinical workstation.
                Last edited by Moderator 1; Nov. 11, 2012, 09:46 PM. Reason: language in quote
                **********
                We move pretty fast for some rabid garden snails.
                -PaulaEdwina

                Comment


                • #9
                  -rereads OP- oh, she got them thursday, i see. what i was reacting to was the month before she can see her doc. well, that's still way too long! hmph. with all this stuff digital these days, i'd think they'd be able to compare the original films a lot quicker. i'll retract two of the 's.
                  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                  Today I will be happier than a bird with a french fry.

                  Comment


                  • #10
                    Originally posted by charismaryllis View Post
                    -rereads OP- oh, she got them thursday, i see. what i was reacting to was the month before she can see her doc. well, that's still way too long! hmph. with all this stuff digital these days, i'd think they'd be able to compare the original films a lot quicker. i'll retract two of the 's.
                    Very few (if any) radiologists would even read the current study (X-ray) unless and until they had the prior exam (CT) available for comparison.

                    The report for the X-ray should reference that prior CT study and should speak to the progress of healing compared to the prior exam. This is absolutely standard practice and if for some reason, the prior study is not available, generally the report will state that fact.

                    If there is nothing concerning about the follow up X-ray, it's unlikely that there is any harm in arranging for a follow up appointment in a month's time (and in fact, that may well be appropriate since there would likely be another plain film acquired at that time to track the continued healing.)

                    There has been a great deal of progress made with respect to creating digital medical records in the US (and actually most imaging facilities went digital many years before the rest of medicine) ... but the interoperability between those systems is still in its infancy. In practical terms, that means that patients are well served to be the keepers of their own medical records, and to be good advocates for themselves when it comes to ensuring that their caregivers have access to all the historical treatment information they can get.
                    **********
                    We move pretty fast for some rabid garden snails.
                    -PaulaEdwina

                    Comment


                    • #11
                      RN chiming in here.....

                      Your photo is upside down anatomically. I think you should have a doctor explain this. I think I see a narrowing but also L4,5,S1 not clear either. Not my thing....
                      The Best test for discs is an MRI imho. A CT will do.
                      Be pushy on the phone. DEMAND satisfaction. Go INTO the office and glare at the office staff. Talk to a nurse when you're there. Demand attention. It's your right.
                      Never, ever fear asking questions!!
                      Until you get explanations; rest and stay off horses. The doc who ordered the test is legally responsible for explaining the results. And is supposed to send them on to the referral doc. But I personally prefer to take the records/films to the referral docs office myself. No delay, no problems. Just sayin'!!
                      Best wishes!

                      Comment


                      • #12
                        Wateryglen, what do you mean when you say the photo is upside down anatomically? I'm confused, bc the image is correct. I couldn't find an image in the first thread.

                        OP, sorry, no new advice. I would get copies of the radiologists' reports for both, and call the doctor that referred you to at least get a quick explanation of the results. I would want a little information since the follow up isn't for a month. He may be difficult to get in touch with, but he should be able to return a phone call. All you probably want to hear is that you will be okay to wait a month to see him, and to know that no new restrictions should be followed.

                        Comment

                        • Original Poster

                          #13
                          Just an update - I took in my Xray on Monday (because my CT wasn't enough) and They said they'd call me in a couple of days. on Thursday I called and the receptionist said that she would make sure they got looked at in a couple of days.
                          I got pissed and told her that it is bull[edit]t that they haven't even looked at them. She then put me on hold and when she got back she said they would get looked at by the end of the day. I still have yet to hear from them.

                          I feel really good and am not in pain anymore - the bump could just be part of the healing process - who knows. I almost feel like just riding because I am so frustrated. I suppose if something is wrong and they took this wrong to get back at me I feel like I should be able to get some sort of legal thing going on here.

                          As far as I know I'm pretty sure the xray picture is upright, as I was going by the words on the bottom. I also know that it is the top side of my vertebrae that got chipped, not the bottom.


                          ETA:
                          I did pull up my medical records and this is what it says on the CT scan findings. Does anyone know what this means? I have no idea. I'm calling them again today

                          NDICATION/HISTORY: L2 fracture. Followup exam.

                          TECHNIQUE: Thin section axial imaging was performed with
                          sagittal and coronal reformats according to protocol. All
                          patients (including pediatric patients) were imaged with dose
                          reduction techniques.
                          IV CONTRAST: None.
                          MEDICATIONS: None.


                          FINDINGS:
                          Bones: The previously noted fracture involving the anterior
                          margin of the superior endplate of L2 is again identified. In
                          the interval, the fracture fragment has not united but has
                          remained a separate ossicle. In addition, there has been some
                          resorption involving the superior endplate of L2 anteriorly,
                          likely discogenic. There has been no significant height loss
                          centrally or posteriorly involving the L2 vertebral body
                          compared with the prior study. The other bones appear
                          unremarkable.
                          Soft tissues: Unremarkable.

                          IMPRESSION:
                          1. Nonunited fracture involving the anterior aspect of the
                          superior endplate of L2. In fact, there has been some lysis and
                          resorption of bone at this location. I suspect the patient may
                          not develop union at this fracture site. I do not see any
                          paraspinous fluid or soft tissue swelling 2 support a diagnosis
                          of osteomyelitis, and the defect developing in the anterior
                          aspect of the superior endplate of L2 has a sclerotic margin
                          which would also be atypical for infection. However, if there
                          are clinical findings 2 suggested, consider MRI to evaluate for
                          osteomyelitis. However, the CT findings do not suggest
                          osteomyelitis.

                          It does mention separate ossicle... I'm curious if this means I will need a fusion surgery??
                          Last edited by Moderator 1; Nov. 11, 2012, 09:47 PM.
                          Eventers of the West
                          A Facebook group I created for Eventers in the West Region of the U.S.
                          Remy - My OTTB Gelding! Love him to pieces!

                          Comment


                          • #14
                            Usual disclaimers apply, but unless the chip is interfering, I would not think it would need to be addressed. The report even seems to indicate that it's being reabsorbed, which would be a good thing.

                            Comment

                            • Original Poster

                              #15
                              Yeah... although the part where it said "I suspect the patient may
                              not develop union at this fracture site" Kinda freaked me out.
                              I think I'm more bad about the fact that the doctors wont help me more than I am about the x-ray.
                              Eventers of the West
                              A Facebook group I created for Eventers in the West Region of the U.S.
                              Remy - My OTTB Gelding! Love him to pieces!

                              Comment


                              • #16
                                imho!!

                                IMHO....you have a decent sized bone chip off your L2 - it's a non-attached fractured piece that's separated and not healing. A "separate ossicle" is a piece of bone. Likely because of movement I guess. The radiologist guesses it's not gonna heal.
                                I'm sure you know it's not good to have bone pieces off a vertebrae so don't be surprised if they suggest surgery to remove it or fix it. Fortunately it's not pressing on your spine but I wonder if it'd make the disc weaker at that place over the longterm. They may even suggest leaving it alone. Because there has been "no loss of disc space" your disc there is stable/normal right now. The "space" or "height" is the space between each vertebrae where the disc resides and doesn't show on xrays. Also good is that it's possibly reabsorbing and that there is no soft tissue problems around it. Seems the bone chip isn't bothering the neighboring tissue which is good too.

                                You just gotta sit tight and wait till you talk to them. Write your questions down so you don't forget. I suggest a face to face meeting also. Make sure you ask about prognosis if you continue riding or if you were to fall on that spot again. Things like that.
                                Our best wishes to you.

                                Comment

                                • Original Poster

                                  #17
                                  FINALLY got to hear from my doctor- TURNS OUT I am healing properly. I have no idea why it took two weeks and 5 phone calls to get them to just look at my report.
                                  They also said I could ride as long as I take it easy and make sure to not fall off... so that is some good news.

                                  Thank you, everyone who gave me advice! I really really appreciate you all taking the time to write to me.
                                  Sorry I sounded all whiny :P I was nervous. (and now I'm embarrassed!)
                                  Eventers of the West
                                  A Facebook group I created for Eventers in the West Region of the U.S.
                                  Remy - My OTTB Gelding! Love him to pieces!

                                  Comment


                                  • #18
                                    no, do not feel embarrassed. i agree that it shouldn't have taken that long for them to look at the films. i would have been ringing their phones off the hook too.

                                    glad you're doing OK though.
                                    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                                    Today I will be happier than a bird with a french fry.

                                    Comment


                                    • #19
                                      Just saw this & now that you ave the info, not much help but I'm a PA & have been in ortho, surgery & Fam med so....

                                      For pts have who i order films on, ESP X-rays vs MRI vs ct, I call pt same day when films are uploaded (with digital, gen 30 mins after X-rays r done), I read & have my ma call the patient with my diagnosis or I call them if it's really complex. For very complex pts or when I have specific questions & the radiology report isn't in (gen takes less than 24h), I call the radiologist & have them review the films with me over the phone or ask for a call when the films are done & pt still there. (aka wet read)

                                      Question I have based on report vs what your doc said, is that you might develop a nonunion which doesn't mean you aren't healing.....could have been a typo. Now, in ortho, we loved when radiology was wrong in fact, at my current job, I've found several errors in spine films. But nothing life threatening, just details I saw that correlated with my diagosis and had to have them amend their reports.
                                      And the wise, Jack Daniels drinking, slow-truck-driving, veteran TB handler who took "no shit from no hoss Miss L, y'hear," said: "She aint wrapped too tight."

                                      Comment


                                      • #20
                                        Also, just input from someone much further down the physically declined road... do NOT go against medical advice no matter how frustrated you are. Right now your body needs to heal. 3 months may seem like forever, but not listening and taking it easy can mean pain and lost function for much much longer. Don't risk it. In the grand scheme of things 3 months is nothing.

                                        If you are really missing the horse time now is a good time to clean all tack immaculately, in short sessions as tolerated of course. Design courses for your friends/self/etc, read about things that interest you, play mindless online games to veg out, and if you have a dog this is a great time to do training with them. Lots can be taught in a stationary position. Lots of service dogs receive a lot of training from their disabled human partners and that involves sitting in one spot while dog works around you.

                                        Good luck with healing up. Make sure you are getting adequate sleep, eating well, and your pain management is adequate.
                                        "You are a child of the universe, no less than the trees and the stars;
                                        you have a right to be here." ~ Desiderata by Max Ehrmann

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