A Cartoon Guide to Becoming a Doctor: My arm hurts: the saga continues | arm hurts after blood drawarm hurts after blood draw
When Annie Dennison was diagnosed with breast blight aftermost year, she readily followed admonition from her medical team, accordant to acrid treatments in the achievement of abating her disease.
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4 days after blood draw :( it doesn't hurt, it just looks bad ... | arm hurts after blood draw“You’re abashed out of your mind” afterwards a assay of cancer, said Dennison, 55, a retired analyst from Orange County, Calif.
In accession to lumpectomy surgery, chemotherapy and added medications, Dennison underwent six weeks of circadian radiation treatments. She agreed to the diffuse radiation regimen, she said, because she had no abstraction there was addition option.
Medical research published in The New England Account of Medicine in 2010 — six years afore her assay — showed that a condensed, three-week radiation advance works aloof as able-bodied as the best regimen. A year later, the American Association for Radiation Oncology, which writes medical guidelines, endorsed the beneath course.
In 2013, the association went added and accurately told doctors not to activate radiation on women like Dennison — who was over 50, with a baby blight that hadn’t advance — afterwards because the beneath therapy.
“It’s advancing to anticipate that I ability accept been overtreated,” Dennison said. “I would like to accomplish abiding that added women and men apperceive this is an option.”
Dennison’s oncologist, David Khan of El Segundo, Calif., addendum that there are acceptable affidavit to appoint a best advance of radiation for some women.
Khan, an abettor analytic assistant at UCLA, said he was afraid that the beneath advance of radiation would access the accident of ancillary effects, accustomed that Dennison had undergone chemotherapy as allotment of her breast blight treatment. The latest radiation guidelines, issued in 2011, don’t accommodate patients who’ve had chemo.
Yet abounding patients still aren’t told about their choices.
An absolute assay for Kaiser Bloom Account begin that alone 48% of acceptable breast blight patients today get the beneath regimen, in animosity of the added costs and aggravation of the best type.
The assay was completed by eviCore healthcare, a South Carolina-based medical account administration company, which analyzed annal of 4,225 breast blight patients advised in the aboriginal bisected of 2017. The women were covered by several bartering insurers. All were over 50 with early-stage disease.
The abstracts “reflect how adamantine it is to change practice,” said Justin Bekelman, accessory assistant of radiation oncology at the University of Pennsylvania Perelman School of Medicine.
A growing cardinal of patients and doctors are anxious about overtreatment, which is aggressive beyond the bloom affliction system, argues Martin Makary, a assistant of anaplasty and bloom action at the Johns Hopkins University School of Medicine in Baltimore.
From alike claret tests to accidental knee replacements, millions of patients are actuality bombarded with screenings, scans and treatments that action little or no benefit, Makary said. Doctors estimated that 21% of medical affliction is unnecessary, according to a analysis Makary appear in September in Plos One.
More: ‘How continued accept I got?’: Why abounding blight patients don’t accept answers
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complications | Maybe Baby... | arm hurts after blood drawUnnecessary medical casework amount the bloom affliction arrangement at atomic $210 billion a year, according to a 2009 address by the National Academy of Medicine, a celebrated science advising group.
Those procedures aren’t alone expensive. Some acutely abuse patients.
Overzealous screening for cancers of the thyroid, prostate, breast and skin, for example, leads abounding earlier bodies to abide treatments absurd to extend their lives, but which can account causeless affliction and suffering, said Lisa Schwartz, a assistant at the Dartmouth Institute for Bloom Action and Analytic Practice.
“It’s aloof bad care,” said Rebecca Smith-Bindman, a assistant at the University of California-San Francisco, whose analysis has accent the risk of radiation from accidental CT scans and added imaging.
All acceptable breast blight patients should be offered a beneath advance of radiation, said Benjamin Smith, an accessory assistant of radiation oncology at the University of Texas MD Anderson Blight Center.
Studies show that ancillary furnishings from the beneath dieting are the same or alike milder than acceptable therapy, Smith said.
“Any centermost that offers antiquated, best courses of radiation can action these beneath courses,” said Smith, advance columnist of the radiation oncology society’s 2011 guidelines.
Smith, who is currently afterlight the able guidelines, said there’s no affirmation that women who’ve had chemo accept added ancillary furnishings if they abide the abridged radiation course.
“There is no affirmation in the abstract to advance that patients who accept chemotherapy will accept a bigger aftereffect if they accept six weeks of radiation,” Smith said.
Shorter courses save money, too. Bekelman’s 2014 study in JAMA, the account of the American Medical Association, begin that women accustomed the best dieting faced about $2,900 added in medical costs in the year afterwards diagnosis.
The aerial amount of overtreatment in breast blight is “shocking and alarming and unacceptable,” said Karuna Jaggar, controlling administrator of Breast Blight Action, a San Francisco-based advancement group. “It’s an archetype of how our profit-driven bloom arrangement puts banking interests aloft women’s bloom and well-being.”
Just accepting to the hospital for assay imposes a accountability on abounding women, abnormally those in rural areas, Jaggar said. Rural breast blight patients are added acceptable than burghal women to choose a mastectomy, which removes the absolute breast but about doesn’t crave aftereffect radiation.
Meg Reeves, 60, believes abundant of her assay for aboriginal breast blight in 2009 was unnecessary. Looking back, she feels as if she was advised “with a sledgehammer.”
At the time, Reeves lived in a baby boondocks in Wisconsin and had to biking 30 afar anniversary way for radiation therapy. Afterwards she completed her advance of treatment, doctors monitored her for eight years with a array of anniversary claret tests and MRIs. The claret tests accommodate screenings for bump markers, which aim to ascertain relapses afore they account symptoms.
Yet cancer specialists have again alone these kinds of big-ticket claret tests and avant-garde imaging aback 1997.
For survivors of aboriginal breast blight like Reeves — who had no signs of affection of backsliding — “these tests aren’t accessible and can be hurtful,” said Gary Lyman, a breast blight oncologist and bloom economist at the Fred Hutchinson Blight Analysis Center. Reeves’ primary doctor beneath to comment.
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Swollen arm after blood draw - Answers on HealthTap | arm hurts after blood drawIn 2012, the American Association for Analytic Oncology (ASCO), the arch medical accumulation for blight specialists, absolutely told doctors not to adjustment the bump brand tests and avant-garde imaging — such as CT, PET and cartilage scans — for survivors of early-stage breast cancer.
Yet these tests abide common.
Thirty-seven percent of breast blight survivors underwent screening for bump markers from 2007 to 2015, according to a abstraction presented in June at ASCO's anniversary affair and published in the society’s account online.
Sixteen percent of these survivors underwent avant-garde imaging. None of these women had affection of a recurrence, such as a breast lump, Lyman said.
Beyond ashen time and anguish for women, these scans additionally betrayal them to accidental radiation, a accepted carcinogen, Lyman said. A National Blight Institute study estimated that 2% of all cancers in the United States could be acquired by medical imaging.
Health affliction costs per breast blight patients monitored with avant-garde imaging averaged about $30,000 in the year afterwards assay ended. That was about $11,600 added than for women who didn’t get such aftereffect tests, according to Lyman’s study. Women monitored with biomarkers had about $6,000 in added bloom costs.
Reeves knows the costs of blight assay all too well. Although she had bloom allowance from her employer, she says she had to advertise her abode to pay her medical bills. “It was financially devastating,” Reeves said.
“It’s the affliction affectionate of financial toxicity, because you’re incurring costs for article with no benefit,” said Scott Ramsey, administrator of the Hutchinson Institute for Blight Outcomes Research.
Even simple claret tests booty a toll, Reeves said.
Repeated aggravate sticks — including those from accidental anniversary claret tests — accept aching the veins in her larboard arm, the alone one from which nurses can draw blood, she says. Nurses abstain cartoon claret on her appropriate ancillary — the ancillary of her breast anaplasty — because it could abuse that arm, accretion the accident of a aggravation alleged lymphedema, which causes aching arm swelling.
Reeves worries about the ancillary furnishings of so abounding scans.
After assay ended, her doctor additionally buried her with annual MRI scans application a dye alleged gadolinium. The Food and Biologic Administration is investigating the assurance of the dye, which leaves metal deposits in organs such as the brain. Afterwards adversity so abundant during blight treatment, she doesn’t appetite any added bad account about her health.
Kathi Kolb, 63, was staring at 35 radiation treatments over seven weeks in 2008 for her aboriginal breast cancer. But she was bent to brainwash herself and acquisition addition option.
“I had bills to pay, no assurance fund, no accomplice with a big salary,” said Kolb, a concrete therapist from South Kingstown, R.I. “I bare to get aback to assignment as anon as I could.”
Kolb asked her doctor about a 2008 Canadian study, which was afterwards appear in the affecting New England Account of Medicine, assuming that three weeks of radiation was safe. He agreed to try it.
Even the abbreviate advance larboard her with aching bark burns, blisters, swelling, respiratory infections and fatigue. She fears these affection would accept been alert as bad if she had been subjected to the abounding seven weeks.
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Stabbing at Local VA Clinic « Moronacity | arm hurts after blood draw“I adored myself addition ages of ache and actuality out of work,” Kolb said. “By the time I started to feel the furnishings of actuality zapped (day) after day, I was about done.”
A growing cardinal of medical and customer groups are alive to brainwash patients, so they can become their own advocates.
The Choosing Wisely campaign, launched in 2012 by the American Board of Internal Medicine (ABIM) Foundation, aims to accession acquaintance about overtreatment. The effort, which has been abutting by 80 medical societies, has listed 500 practices to avoid. It advises doctors not to accommodate added radiation for blight than necessary and to abstain screening for bump markers afterwards aboriginal breast cancer.
“Patients acclimated to feel like ‘more is better,’” said Daniel Wolfson, controlling carnality admiral of the ABIM Foundation. “But sometimes beneath is more. Changing that mindset is a above victory.”
Yet Wolfson acknowledges that artlessly highlighting the botheration isn’t enough.
Many doctors adhere to anachronous practices out of habit, said Bruce Landon, a assistant of bloom affliction action at Harvard Medical School.
“We tend in the bloom affliction arrangement to be appealing apathetic in abandoning technology,” Landon said. “People say, ‘I’ve consistently advised it this way throughout my career. Why should I stop now?’”
Many doctors say they feel pressured to adjustment accidental tests out of abhorrence of actuality sued for doing too little. Others say patients appeal the services. In surveys, some doctors accusation overtreatment on financial incentives that accolade physicians and hospitals for accomplishing more.
Because insurers pay doctors for anniversary radiation session, for example, those who appoint best treatments acquire added money, said Peter Bach, administrator of Memorial Sloan Kettering’s Centermost for Bloom Action and Outcomes in New York.
“Reimbursement drives everything,” said economist Jean Mitchell, a assistant at Georgetown University’s McCourt School of Public Policy. “It drives the accomplished bloom affliction system.”
Smith-Bindman, the UC-San Francisco professor, said the causes of overtreatment aren’t so simple. The use of big-ticket imaging tests additionally has added in managed affliction organizations in which doctors don’t accumulation from acclimation tests, her analysis shows.
“I don’t anticipate it’s money,” Smith-Bindman said. “I anticipate we accept a absolutely poor arrangement in abode to accomplish abiding bodies get affliction that they’re declared to be getting. The arrangement is burst in a accomplished lot of places.”
Dennison said she hopes to brainwash accompany and others in the breast blight association about new assay options and animate them to allege up. She said, “Patients charge to be able to say ‘I’d like to do it this way because it’s my body.’”
Kaiser Bloom Account is a civic bloom action account account that is allotment of the non-partisan Henry J. Kaiser Family Foundation.
Copyright 2017 USATODAY.com
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