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To dye, or not to dye...that is the question

Posted by wendyn on 2/14/05 at 22:27 (169065)

Whether 'tis nobler in the mind's eye to suffer the slings and arrows of outrageous medicine.....yada yada

So, I called the doctor's office this morning. The perpetually confused receptionist was befuddled as usual; she said that there was no dye ordered and that she always thought the doctor decided what type of tests to have done. I had hoped to hear back from the doctor herself before my appoinment; however, I did not. Although the receptionist is very friendly and pleasant, she is not always very organized.

I arrived at the hospital 45 minutes prior to my appointment as instructed. My appt was scheduled for 1:00. The nurse who I spoke with yesterday agreed to find said mystery doctor who has determined that I require dye. I am not sure if this mystery person is a radiologist or a doctor, or if there is a difference - she seemed to refer to him by both names.

At 1:15 (15 minutes after my appointment was to have started, she came back and said that the doctor did not need to talk to me yet. They would do the test without contrast and then, if the contrast was needed, the doctor would come in and speak with me. No problem.

They popped me in the tube (only up to about chest height) and gave me some good ear plugs (I can't imagine trying to drown out that racket with classical music). The noise is weird, but I found it repetitive enough that I actually dozed off a few times (not good, because my body would jerk a bit as I fell asleep)

Anyway, long story short - the nurse came back in after about 40 minutes. She moved the little capsules that they had taped to my lumps (evidently she had them in the wrong place) and then said oh - yes the doctor does want to use the dye.

Now - I still have never seen this nameless, faceless individual who is calling the shots on my health - I have no idea why he never surfaced as promised. When I asked her why they needed to use dye, she said that it will help them see better. I smiled nicely and said - that's nice, but no thanks.

Now, bear in mind - that through all of the tests I've been through - none of them, not ONE - has shown anything of any use. In my mind, you can look at nothing with, or without dye.

I had really hoped to have an intelligent conversation with a medical professional who could help me make an informed choice. But, since that wasn't going to happen, I was content to decline. Maybe, just maybe, they found something that they would have been able to see better with dye. If so, then someone should have been able to explain the benefits of doing this with the contrast.

45 minutes back in the tube, and then they sent me off for 3 xrays of both feet. No one explained why I had to go for more xrays, nor did they care that my doctor had already ordered another set of xrays. If I had already done the series for the rheumatologist (I had just not gotten to the lab yet), then the hospital would have just made me redo them again today! They wanted their own xrays done.

And therein lies my issue. No one is overly concerned that I have had approximately 20 xrays in the last 2 years alone. No one except me. I am so very tired of doctors being more concerned about my feet than they are of ME.

5 years ago I ended up so frustrated with medical professionals and tests that I quit going all together. Everything. I wouldn't even have my teeth cleaned for 2 years. Gross - I know, but I just couldn't stand it anymore. Now I am remembering how I got to that point. Between the physio now with the pins, the tests on my feet, and the problems with my eyes (don't even get me started) I just want it all to go away.

That is my rant for this evening - oh and yes, I have to go back for another hour in the tube one day for my left foot. Likely so they can look at more of nothing.

But, I digress...

Thank you all for putting up with me!

Re: To dye, or not to dye...that is the question

elliott on 2/14/05 at 23:20 (169067)

Wendyn, a few comments:

You don't get to see the radiologist because radiologists selected their profession precisely because they don't want to have to deal with people, as they are as a general rule about as anti-social as they come. Only once in my life did I actually get to meet with the radiologist; all the other times they stayed hidden, with the nurse making it clear that I just cannot see the man behind the curtain. In your case, if he would have come out and talked to you a bit, he might have convinced you to to take the dye, but that would mean actually having to meet you (not worth it to him).

I'd bet all those X-rays are more dangerous than the dye. Advise to stop getting unnecessary X-rays--if you have a current set taken at the necessary angles, decline the rest. In future get copies to take with you, or if impossible, have them forwarded.

See also my post in the previous thread.


Re: Radiologists

Julie on 2/15/05 at 02:54 (169070)

Elliott, that's interesting. I suspected as much. When the radiologist who reported on my MRI declared he had spotted a neurofibroma, my osteopath tried to call him for more information, but he was 'out'. When I went for the second MRI, I asked to speak to him, but was told I couldn't - that all communication had to be with the referring doctor (i.e.my osteopath, who had already been stymied).

When my neurosurgeon opined that the foreign object clearly visible on the MRI pictures was not a neurofibroma, but a wandering disc fragment, saying that he thought this because of the sudden onset of the pain, I began to wonder. Had the radiologist not read the referral form which clearly stated 'Sudden onset of lumbar pain'?

The surgery proved the surgeon right, and a couple of weeks ago I decided to write to the radiologist apprising him of the situation and inquiring whether he had read the referral form, and if so why he had not picked up 'sudden onset' (which should have steered him right away from the neurofibroma diagnosis). We had been put quite unnecessarily through several weeks of anxiety about a tumour on my spine (almost certainly benign, as neurofibromas tend to be, but given my history the possibility of malignancy could not be ruled out) which would have required more complex surgery, lifelong monitoring, and a good possibility, with tumour growth, of more surgery in later years.

I am still waiting for an answer.

This isn't especially relevant to Wendy's situation - just another comment on radiologists.

Re: To dye, or not to dye...that is the question

Julie on 2/15/05 at 03:08 (169071)

Hi Wendy

I wrote my response to Elliott's post before reading yours. I am very sorry, but not surprised, given my own exeprience with a radiologist, that you've had this unsatisfactory experience. I would guess that it was never likely that you would get the chance to speak to him, and under the circumstances I understand why you refused the dye. And why you need to rant. Rant away - we're here to listen, and there's nothing to put up with.

That reminds me of something my dentist said to me yesterday. I had been three hours in the chair, from 10am to 1pm, while he made me a state-of-the-art restoration (i.e. a big filling to replace one that had crumbled away) with his state-of-the-art new computerised crown-and-restoration-making machine. (It was a perfect filling when it emerged, but it took an unconscionably long time!). Anyway, at 1 o clock, when he finished, I said 'Now you have a little space between Friedebergers (Klaus had an appointment at 3). And he said 'We don't need a space - I would happily treat the two of you all day long. Neither of you is any trouble'.

Nothing to put up with with us either, apparently. I was ever so pleased.

I hope you're sleeping peacefully as I write and that you'll be feeling less frustrated and cross this morning.

Re: To dye, or not to dye...that is the question

Dr. Zuckerman on 2/15/05 at 07:50 (169080)

I don't believe the radiologist has the right to order the dye period. He may suggest the dye to your Treating doctor but they don't get directly involved with ordering of tests or not. They will call the treating doctor and make recommendations.
If your treating doctor wanted to use dye it had to be on the prescriptoin that ordered the MRI.
Using dye for foot MRI is so rare but can be helpful in very select cases

Re: To dye, or not to dye...that is the question

Julie on 2/15/05 at 07:57 (169081)

Dr Z, I don't understand this. The radiologist's job is to read the MRI and give a view on what whatever s/he sees on the pictures might be. That is his area of specialism. If there is something that can be seen, but not seen sufficiently clearly to pronounce on what it is without contrast being used, surely it is the radiologist who orders it? Who else would?

Re: To dye, or not to dye...that is the question

Dr. Zuckerman on 2/15/05 at 11:00 (169088)

The Radiologist makes a recommendation, which usually the treating physician follows. The radiologist is looking at films he never examines the patient which places him in a very difficult position to make a diagnosis that is perfect. It always states on the report please confirm this with clinical findings. I can't tell you how many times I have read this is a bone infection and there wasn't any signs of infection in the foot.
So the evaluation of the MRI MUST be in conjunction with the physical findings of the treating physician.

Re: To dye, or not to dye...that is the question

Julie on 2/15/05 at 11:13 (169089)

Of course.

But what you actually said is that the radiologist 'has no right to order dye', and that's what I didn't understand. If the treating physician does not know what the problem is, and orders an MRI to help identify it, s/he doesn't know whether or not contrast will be needed and it is surely the radiologist who must determine whether or not it is?

I am not a doctor :) and am not arguing with you. I am just puzzled by what you said, which didn't tie up with my limited experience.

Re: To dye, or not to dye...that is the question

Dr. Zuckerman on 2/15/05 at 11:22 (169090)

He doesn't . He asked the treating doctor to order the dye. I would be very angry if a radiologist ordered any testing without a consultation with an explanation as why he wants to do this or that. This is typically what happens. There is a phone consultation between the radiolgist and the treating doctor. This is something that the patient usually isn't aware of . I do know that the treating doctor has to write the order if the radiologist does in fact request a dye added to the testing.
This might have something also to do with self referral regualations. This is so routine that I have to think about it . All of my encounters with radiologys always go along with a consultation either in writing and or via the phone. This by means is saying that the radiologist isn't skilles and very important its just that they don't order testing without a consultation with the treating doctor being adviced. I hope this is clearer

Re: To dye, or not to dye...that is the question

John H on 2/15/05 at 12:01 (169091)

One thing I have found after many MRI's, X-Rays,CAT Scans,etc is the the Doctor ordering the procedure always wants to view the film himself and does not seem to rely heavily on the report from the Radiologist. This seems strange as the Radiologist is trained in reading film,etc. A report from a Radiologist has never been enough for any Doctor I have seen. Even broken toes and fingers.

Re: die, dye!

elliott on 2/15/05 at 12:12 (169092)

Couldn't resist the title, since it seems to reflect wendyn's sentiments.

Julie, I think Dr. Z's right, at least in the U.S. The doc orders tests, and the radiologist just reads them, that's all. If it doesn't say dye, he doesn't do it. Often, the doc has a relationship with that radiologist or at least some radiologist, and they confer, and so the doc already has a good idea as to when dye is appropriate, but the prescription/referral whatever you want to call it must come from the doc.

Hard to tell who's in charge in Wendy's case. I still feel all those X-rays is a disgrace.

Re: die, dye!

Julie on 2/15/05 at 14:07 (169097)

Me too, re Wendy's Xrays: the result of non-joined-up thinking.

Re radiologists and dye - my own limited experience was an MRI ordered by my practitioner, and then a second MRI, avec die, at the request of the radiologist, who wanted a closer/clearer look. That's why I didn't understand what Dr Z was saying, and asked.

Re: To dye, or not to dye...that is the question

Julie on 2/15/05 at 14:13 (169098)

Yes, it is: thank you very much. See my post to Elliott for my reason for asking. In the case of my MRI, the reporting radiologist either wasn't skilled, or didn't bother to read the referral report (which makes nonsense of the protocol you describe) and made a bad mistake that caused me a great deal of needless anxiety until the real cause of the problem was found.

It's possible that the protocol is slightly different here (though I wouldn't know), where the hierarchy is such that any consultant is deemed to be above any GP - I would guess that a consultant radiologist would not take kindly to being told by a GP whether he should or shouldn't use dye. But I'm guessing. Thanks for your clarification.

Re: die, dye!

Dr. Z on 2/15/05 at 17:41 (169107)


Dye is usually ordered for brain and spinal cord. The radiologist and the doctor should be working together and the doctor should know when to order and when not to order dye.
I just can't see where the dye is going to make a difference with the foot and ankle. Now if it could see nerves maybe that would really make a difference

Re: To dye, or not to dye...that is the question

Kathy G on 2/15/05 at 17:57 (169110)

The only time I ever spoke to a radiologist was way back in the olden days when the most advanced xray technology was a cat scan. It was when I was twenty-six or twenty-seven and they were 'ruling out a brain tumor.' They did the test then wanted to use the dye and I flat out refused.

The radiologist, a kind, gentle man, came in and spoke to me. He explain why they wanted to use the dye, what it would do and then asked me about my fear. He actually sat down with me and listened. I told him about visiting my mother in the hospital when I was seventeen when her roommate was brought back in a straight jacket after having a cat scan. I overheard the nurses saying something about dye. That's all I needed to hear. He then told me that in rare cases, people get a reaction, similar to anyphylactic shock, to the dye but that it's very rare and he even showed me all the meds they had standing by if it happened. He then proceeded to sit with me while they set up the IV and then went back to read it. I had no tumor and I guess I had a brain! I never forgot his kindness.

Later, discussing it with my mother, I realized that the lady in her room had severe pschiatric problems and the cat scan had just pushed her over the edge, but it sure scared me!

I believe that radiologists and anesthesiologists are not necessarily the best professionals when it comes to relating to the patients but they sure are essential to us.

Re: To dye, or not to dye...that is the question

john h on 2/15/05 at 18:46 (169112)

Kathy: They certainly are among the most sued by our trial lawyers.

Re: To dye, or not to dye...that is the question

john h on 2/15/05 at 18:53 (169113)

Last night my daughter x-rayed and gave a CAT scan to a lady with a large kidney stone. The lady advised her she only had one kidney. My daughter performed the CT scan and called the radiologist and informed him the lady in fact had both kidneys. She sent the CT scan by computer to the radiologist who receives them from about 7 hospitals and reads them. He called her back and confirmed she did indeed have both kidneys and figured she would be both happy and mad at whoever advised her she had one kidney. She was from out of town and apparently had been told 20 years ago she only had one kidney. Another lady came in with a kidney stone that was 10 cm and about 2' down into the ureter. That is one big kidney stone and almost no chance of passing it. Her Doctor is my Doctor and he met her at 5am this morning to do a successful ESWL. After all this I met a lady this morning who said she had only one kidney (congenital defect) and she had a kidney stone. Must be something in the air.

Re: Dye hard

wendyn on 2/15/05 at 23:06 (169123)

Thanks elliot. I find it somewhat comforting knowing that I probably didn't experience anything that I should take personally!

(The man behind the curtain - now I picture the radiologist as the Wizard of Oz)

I agree on the xrays - I'm done.

Re: To dye, or not to dye...that is the question

wendyn on 2/15/05 at 23:07 (169124)

Yes Julie - actually, I had an excellent day - and I was in a very good mood. Evidently, I got it all out of my system last night!

Re: Only the good dye young

wendyn on 2/15/05 at 23:08 (169125)

elliot - with respect to who is in charge in my case...as of yesterday...


Re: Only the good dye young

wendyn on 2/15/05 at 23:09 (169126)

Kathy, that's the type of conversation I was looking for. That type of reassurance would go a long way. Oh, well - I am glad that everything worked out in your case, and that you had a patient radiologist (who wasn't afraid of people)

Re: Thanks Dr Z

Julie on 2/16/05 at 01:31 (169131)


Re: To dye, or not to dye...that is the question

John H on 2/16/05 at 09:28 (169144)

My daughter has worked in radiology for about 22 years in a very large hospital. She routinely performs procedures using dye of both types nearly every day. She tells me it is extremely rare that anyone has a reaction. Sometimes with a kidney stone it causes immediate and severe pain as the dye immediately reaches the kidneys and forces the stone in the ureter to move causing pain. It is not the dye itself. For those who are allergic there is a dye that is sort of hypo allergenic but this dye is very expensive and they do not use it unless the patient has a history of allergic reactions.

Re: die, dye!

John H on 2/16/05 at 09:32 (169145)

Some radiological protocols call for dye in all instances. For example a myleogram. There are many more. It is just part of the procedure.

Re: To dye, or not to dye...that is the question

Julie on 2/16/05 at 09:33 (169146)

Wendy, I'm so glad to hear it. I hope today is even better.

Re: To dye, or not to dye...that is the question

John H on 2/16/05 at 09:43 (169148)

Many practicing GPs would not know whether dye was required or not. A specialist would in most cases. Our family GP ordered an MRI on my wifes brain some years ago. There is a standard protocol for this type of MRI which required dye. The GP did not tell the Radiologist how to do it as he does thousands of them and knows how best to perform it to get the best view possible. When the Radiologist found something he sent his report back to the GP who referred my wife on to a Neurosurgeon who determined she had a benign calcium deposite just below the scalp. If you have a kidney stone or suspected one a CAT Scan with a Kidney Stone Protocol is ordered. There is a standard protocol form most MRI's and CAT scans. Some call for dye and some do not. I have never heard a patient refuse dye when it was part of the protocol else why have the procedure at all. When I had a dye put in my spinal canal it was not a matter of choice it was part of the procedure and would have been a useless procedure without the dye.

Re: It sounds like the dye is cast...

Suzanne D. on 2/16/05 at 11:33 (169158)

Hi, Wendy! I'm just trying a little humor here and wanted to let you know that I appreciated yours!('Only the good dye young', 'dye hard', 'to dye or not to dye...')

Of course it occured to me that if you haven't heard the expression 'the dye is cast' it would make no sense at all! :)

Anyway, I admire your witty sense of humor in the face of pain and frustration.

Best wishes,
Suzanne :)

Re: To dye, or not to dye...that is the question

marie on 2/16/05 at 17:34 (169184)

I had a very good experience in radiologist. I did get to meet him and he was a very sweet older gentleman. However I too have known many unsociable radiologists so when I met the man that was going to be reading my MRI I was relieved. The MRI technician did stop my test and called the doc to get permission for dye as she felt she saw something that needed a closer look. It took about 20 minutes to get everyone contacted but i was kept abreast of everyone that was involved........even though they would not reveal why they thought I should have dye.

Anyhoooooooo I think it helps if the patient is at least informed of the procedure and who is involved.


Re: To dye, or not to dye...that is the question

wendyn on 2/16/05 at 22:25 (169213)

Marie, did they find anything interesting with the dye?

Re: It sounds like the dye is cast...

wendyn on 2/16/05 at 22:26 (169215)

Suzanne, I am familiar with the phrase, and I'm glad you could play along!