Have to get GBCA- Enhanced MRI: Brief Advice.

If you have to get a GBCA-enhanced MRI and are nervous about toxicity. Here is brief advice I just gave to someone:

GDD is relatively rare, so your absolute risk is low. That said, make sure you are relatively well hydrated before the study and afterwards... but do not overdo it. Do not over exercise before or after, do not take any high potency drugs like antibiotics - if you are unavoidably on them, then delay MRI. Essentially you want to avoid anything that may throw off the balance of your immune system.

You could take tumeric, spirulina, chlorella... maybe just tumeric fine... eat healthy food.

Some additional notes are important.

If you already have GDD, then you should never get another GBCA injection again. There are always alternatives to everything. Including most importantly don't get any imaging... I must admit I am amazed at the number of GDD sufferers who rush to get other imaging studies when a physician tells them they need one (often the study is obtained to investigate the symptoms that turn out to be GDD, and the study is of no value). I ask myself... you already had a physician or practitioner tell you to get an MRI with GBCA, and now you are extremely sick with GDD, and your are willing to jump in and get another imaging study of dubious value? Really?

We do far too many imaging studies for very weak reasoning, often times the reason is so the practitioner does not get sued (cover-the-ass medicine).

The reason for cover-the-ass medicine is that physicians can get sued for things that have a 1 in 100,000 chance of occurring. The obvious thing is to start by changing simple things, as I have said previously: all medical experts should be agents of the court, or if we have not progressed to that logic, then atleast medical experts should be liable for what they say, and medical experts should be actual medical experts and not scam-artist physicians for hire.

I have digressed....I must admit I try to couch when I talk to patients, evaluating risks in terms : "this is what I would do", a physician who knows an enormous amount about medicine, imaging and risks, Quite often my advice is: I would do nothing. To illustrate the point, I punctured my eardrum about 1.5 years ago, instead of it healing with no problem I have hearing loss and white noise in that ear. I went eventually to get it looked at. I saw a nurse practitioner who told me I needed to get a CT of the temporal bone and an MR with GBCA, the latter to exclude an acoustic neuroma. What did I do? Nothing.

I would get a CT in the setting of major trauma, and if I thought I had interstitial lung disease. To date I have never undergone CT, because of the radiation risk, for any indication of marginal likelihood of value. Other imaging to me, in particular Nuclear Medicine and PET, are quite horrifying.

The problem ofcourse with telling people to not get imaging, is that anything can happen 1 in 100,000 or 1 in 1 million times, anything. Some things like heart disease are very common, even without GDD. So often we practice medicine for the 1 in 100,000 probability, but ignore things that are 100%- if you have GDD and you get another GBCA injection 100% of the time you will get worse..

So studying for example with a GBCA-enhanced MRI of the pancreas for an insulinoma, out of the blue, without good reasoning, there is perhaps 1 in 1 million chance you will have an islet cell tumor of some kind, but if you already have GDD your chance of getting worse from GDD is 100%, your chance of getting GDD if you don't have it, is 1 in 10,000 for mild disease and 1 in 100,000 for severe disease. With CT, probably 1 in 10,000 (as high as 1 in 2,000 depending on how many passes) chance of getting cancer from the study, 1 in 10,000 chance of permanent kidney injury, 1 in 10,000 of moderate severity acute hypersensitivity reaction, and 1 in 300,000 chance of death from anaphylactoid reaction to iodine contrast.

There are an enormous number of potential risk elements to essentially everything. In most respects one just has to accept that everything carries risks, and often different scenarios possess competing risks, and just accept that. But be sure you have a relatively good idea of the various risks, and more importantly their likelihood.

It seems most often what happens is that physicians get blamed for things that have a 1 in 100,000 probability that it will occur, and even more commonly, patients get ignored when they have iatrogenic diseases that could be avoided, at least from getting worse, because doctors fear they will be held responsible.. so better to deny it exists. This latter is the common story of GDD.

Richard Semelka, MD.