Chest X-Ray

[mshistory]

My rheumy has ordered a chest x-ray because of my chronic dry cough, occasional shortness of breath and coughing when I take a deep breath, and occasional chest pain. He said that x-rays typically don't show small issues but insurance won't cover a CT scan unless an x-ray justifies it. Has anyone else had a similar issue and what was the outcome? It seems silly to me that if there is something going on with my lungs but it's still in the early stages that I would have to wait until it gets bad enough to show up on an x-ray just to get properly diagnosed (gosh, isn't that the story of our lives though?)!

[buddybelle]

I also have intermittent shorness of breath and chest discomfort. I have nodular densities on my lungs. They come and go on the xrays. They are mucous plugs. The quality of my saliva is the problem.  My bronchial tubes are dry and thick saliva ends up in my lungs.
Just keep the doctor informed of any symptoms. I have had pneumonia twice in the last year.

I hope this helps,
Buddybelle

[irish]

We need to take our lungs very seriously as many sjogrens patients have issues. The big thing with the lungs is the dryness causes the thick mucus to plug the bronchial tubes and this increases chance of infection. Also, it causes the hacking. The lungs know that there is something there that shouldn't be and try to cough to expel it from the braonchials.

Also, people with sjogrens are often told that they have asthma (and they very well may have it) but often it is the sjogrens that precipitates the asthma symptoms. Hacking, bronchial spasms, wheezing, etc. Know that there are times that you could feel like something is rattling in your chest and the doctors won't hear it. It has happened to me many times.

I was not crazy!!! It is the thick mucus handing on the walls of the bronchioles and vibrating when air is exchanged. Often times your GP will not take this seriously enough and you need to see a pulmonary or lung specialist in order to get a lung assessment. Be aware that you will need inhalers to help expand the airway. Make sure to run a humidifier in the house to help keep your lung tissues more moist. This makes you feel better and it also helps to decrease the chance of infection.

Dry lung tissues can't fight off infections. The mucus we have is not normal and it doesn't provide the lubrication that the tissue needs or the right kind of bacteria and enzymes to help keep the lungs infection free and healthy.  Good luck. Irish

[mshistory]

Thanks Buddybelle and Irish - that makes sense about the thickened mucus in our lungs. Which reminds me - I've got to ask my dr. about the pneumonia vaccine!

[anita]

I think you need to look at your insurance coverage yourself, because this does not sound right.  A CT should be covered by most basic plans and it's warranted for your symtpoms.

[mshistory]

I think you need to look at your insurance coverage yourself, because this does not sound right.  A CT should be covered by most basic plans and it's warranted for your symtpoms.

That's what I would think, too - that a doctor should be able to order any test that he feels is most appropriate...? My rheumatologist is the one who told me they couldn't order the CT scan without going through the x-ray first. My younger daughter had to have a CT scan for her cranial sutures because she was born with torticollis and plagiocephaly, and we didn't have to have any sort of x-ray first - the pediatric neurosurgeon just ordered the CT scan, we got the pre-cert and we had the scan done. I just find this confusing 

[anita]

I don't think it has anything to do with your insurance...because he would have had to at least try and had it denied...and he didn't even try.  Doesn't sound like he even checked with your insurance.  Do you think the rheumy may be dismissing your symptoms and ordering a simple x-ray just to appease you?  I really think you should inquire again about getting the CT if these symptoms have been persistent.  Go to your GP and ask him/her...you may get a different response.

[Iris]

My primary care doctor ordered a CT scan for me and sent me that day for it.. It didn't show anything wrong though which is good I guess but it still doesn't make you feel better when you can't breathe..  I saw my Rheumy yesterday and he said I should see a lung specialist but he did give me a low dose of prednisone to take for awhile..

[mshistory]

anita, if the x-ray turns out "clear" then I'll ask him about a referral to a pulmonary specialist if these issues persist. The things is, he is genuinely concerned and even told me if I continue to lose weight he's going to start testing me from head to toe to figure out why. He's a very good and sympathetic doctor, but he and his nurse were both convinced that I had to have the x-ray first for some reason...if it isn't insurance, then I wonder if it's the hospital policy?? But that wouldn't make sense either. I don't know... I do know he said that if he sees anything even slightly abnormal on the x-ray then he's going to order the CT scan, but he also said CT scans are much more accurate in detecting certain kinds of lung involvement so I just find the whole thing frustrating ... maybe if I'm referred to a lung specialist, they won't need to jump through so many hoops to check my lungs out properly?

Iris, I'm glad your CT scan was clear, but I do understand how it's frustrating to experience symptoms but have no explanation for them!

[Shade]

Hi MS,

We just went through this with my husband.  The doc wanted to order an MRI.  His nurse came in and said, "Oh no, with that insurance company you have to do an x-ray before you can order an MRI.  So DH had an x-ray (it didn't show what was needed), then a week or so later he had an MRI.

In ordered to be covered, some insurance companies have a list of the required order tests must be done.  Of course, with the least expensive test first.  In my husband's case and probably yours, it won't save them (or you) money; but, overall it does save the insurance company money or they wouldn't do it this way.

Hopefully, you will get an answer to what's causing these symptoms soon.

Shade

[Still in the hunt]

again,,,, insurance companies not doing what a doctor wants done,, like irish,, I have pretty dry lungs,, and after the last sinus surgery,, the mucos is thicker, why it chokes me after i eat is a mystery,, but I suspect its glands too,, of course it wont do it on demand,, But i think nect time I see ent I am taking a hndfull of crackers with me,, oh heck any food will do it,, but i do some dympathy,, my wife will say thats a dam shame,, ya right hon,, youand the boys just go ahead and enjoy your pizza

[mshistory]

Thanks Shade and Still in the Hunt - I think like a lot of us, I have a love/hate relationship with my insurance. Without it, we'd be bankrupt by now, but I hate all the red tape and fine print and pre-certs etc.  It would be nice if doctors could just treat us as best as they know how!