Sunday, September 06, 2009

Turning Down an MRI

About six weeks ago I emailed my oncologist about a numbness I had on the right side of my right knee and the sharp pain I had on the knee when I put pressure on it. This condition had persisted for many months. I couldn't remember banging the knee on anything.

I emailed him because I just wanted to check and be sure this wasn't some sort of classic symptom of recurrence of Non-Hodgkins Lymphoma that I had never heard of. With NHL, bad things can happen in the bone marrow, so that's how I developed the knee-pain/NHL hypothesis. (I give the oncologist a lot of credit for responding to my emails - he has a great assistant who handles emails and other contacts with him.) He said for me to come in, and I did.

The doctor, after examining the knee and talking to me, said he didn't know what the pain meant. However, he gives me a lot of credit for being the sort of cancer-patient-in-remission who doesn't get alarmed by this symptom or that. So he said he wanted to order an MRI of the knee and send me to an orthopedic specialist. (He said usually one goes to the orthopod first, then the orthopod orders the MRI, then you go back to the orthopod after the MRI for a consult. He wanted to save me the first trip, so he ordered the MRI and gave me the name of the orthopod.) His office called Baptist Hospital to get the MRI process going.

To make a long story shorter, during the scheduling process I learned that my part of the out-of-pocket cost of the MRI would approach $1000. Furthermore, it was going to cost me most of a morning at Baptist, then the visit with a new physician - a lot of time. All I really wanted from my oncologist was either, "I have never heard of that symptom being related to remission; see you in 6 months for our regular check-up," or "This is a classic symptom of active NHL disease" or "I'm sorry, Paul, with this knee your career in pro football is over; just go back to your practice for the duration." But he took the condition seriously, even if he had no good idea what it came from.

I, however, had the answer I was looking for in the first place: For someone who is in remission from NHL, is the knee clearly an alarm signal? Answer: no. So I sent my doctor an email (again) and said I was not going through with the MRI and many thanks for his help. That was OK with him, because he did not get back to me: a confirmation of the answer I was looking for.

Here's the deal: the MRI meant time and money for me, and I had better uses for it, under the particular circumstances. Had I been "retired" with nothing much to do and if the process would not have cost me anything, then maybe I would have gone through with it, bearing the non-monetary cost of sitting in reception rooms of doctors offices with the other dozing senior citizens, having learned to snooze despite Oprah blaring forth on the ubiquitous TV.

(My knee is much better. I must have banged it on something. I just don't remember banging it. Obviously, the referral should have been to a neurologist.)

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