Bone scans

Bone scans are also very helpful in patients with low back pain. Now, I know you see a lot of low back pain and I don’t expect you to refer patients for a bone scan in every case but somebody who is refractory to therapy, who just isn’t getting better, whose plain films are normal or potentially whose plain films demonstrate spondylolisthesis, a bone scan with SPECT would be indicated in those cases. It’s particularly helpful if it’s an occupational incident, shall we say, or it’s an accident in perhaps a legal case, it is very helpful to get a bone scan. Again, it is the most sensitive thing that we have out there. Once we add SPECT, it is by far the most sensitive diagnostic test we have available. If you have a legal case or an occupational therapy type case and you have a negative bone scan, that can be very helpful.

In the adolescent, spondylolisthesis may or may not be causing the back pain. So if you see a plain film finding of spondylolisthesis, you need to find out if it’s actually causing problems at this time. If there’s an acute problem, if there is bony remodeling, that’s what the bone scan will help you with.

In the vast majority of patients, we will see what we call increased uptake or bony remodeling, which is what our bone scan looks for, within 24 hours. In the elderly, however, it might take up to a week. Keep in mind that we should use it after the x-ray. The age of injury can also be judged. So if you have a nice little old lady who you are assuming is osteoporotic with a compression fracture on her chest x-ray and you have no idea how long it’s been there and now she is complaining of bone pain, you need to know, “Is this acute or is this chronic?”, a bone scan is very helpful.
This is a little bit redundant from a prior study. I just want to reiterate that SPECT does improve both the sensitivity and the specificity for bone and joint related pain.

This is called the PY test. This is a test looking for H. pylori infection. Generally, patients with ulcers, if they are concomitantly infected with H. pylori, their ulcers will recur very rapidly despite appropriate H2 antagonist therapy. There are two clinical indications. One is to make the diagnosis and the other is to document the successful therapy of this disease.
Now, if you are going to be doing an upper endoscopy anyway on this patient to look for the ulcer or for whatever reasons, you don’t need to get this test. You should just do a CLO test. The CLO test is where you take a little biopsy of the ulcer and it’s a $50 test and you get very quick results. It is very little additional cost on top of the endoscopy. On the other hand, if you are going to do an endoscopy just to do a CLO test, that’s a $2000 study and we’ll do this for $200.
This is a very quick test. The patients come in, swallow a capsule, wait 10 minutes, they breathe into a little bag and they’re gone. It’s very fast. I think it’s really quite inexpensive. It’s one of the least expensive things that I do anyway. There are quite a few medications that will interfere with the test and the way to remember this is they don’t get any antibiotics for one month, they don’t get any Prilosec or omeprazole for one week and there is no H2 antagonist for one day prior to the test. These will all cause false negative tests because you are, to some degree, treating the disease.

Canadian online pharmacy info

Leave a Reply

Your email address will not be published. Required fields are marked *