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]Hi There,

I am totally confused and very upset about some information I have just discovered. I hope I can explain all of this so that you can understand it, as it spans over the past 20 years.

20 years old patientago, when I was 22 years old patientold, I had a routine physical. At that time, I was found to have microscopic hematuria. I went through cytology, an IVP and a cystoscopy. My diagnosis was idiopathic microscopic hematuria. Because I was a smoker, I was told that I needed to follow up periodically, assuming the hematuria continued.

I need to insert here that I am now 42 years old patientold. I can't believe that I did this, but I continued to smoke until I was 39 years old patientold....for a grand total of 20 years old patientof 1/2 to 1 pack of cigarettes a day. (There was an 18 month period where I was smoke-free, as I was pregnant twice during this time.) I will be smoke-free for four years old patienton December 31st of this year. I haven't so much as taken a puff since then, thank goodness!

My hematuria has never gotten worse, nor has it gotten any better. For the first 10 years, my doctor followed me with IVPs, cystoscopy and cytology. I think I had a total of 3 IVPs. Since that time, we moved from FL to GA. The last (most recent) 10 years old patienthave been followed by a different doctor. She says that she follows the American Urological Associations guidelines for my condition. Over the past 10 years, I have had 3 CT Urographic studies with contrast, cystoscopy and cytology. Things are still totally normal.

Today, I was doing some reading, as I just had my "tests" run last week. The only finding (that was considered unremarkable) was a calcified granuloma in my lung. I have talked to the radiology department that did my CT Urography, and they assured me that this is a benign finding and nothing to follow.

The next thing is what scared me to death. I actually considered having a Pulmonary CT done to make sure that the granuloma is indeed benign. I could not believe what I found. I have been exposed to SO much radiation over the years old patientof having 3 IVPs and 3 CTs with contrast. What I read showed CT Urogram as being one of the HIGHEST radiation level CT procedures in existing.

I had no idea that I was being exposed to so much radiation, as my doctors always told me that we were making sure that cancer had not developed and wasn't causing my continued microscopic hematuria. Now, I feel that I probably will end up with either bladder or renal cancer because of all of the x-rays I had, along with approximately 20 years old patientof smoking.

Today, I am healthier than I have ever been. I am 5' 5'' and weigh 130 pounds. I walk 5 miles each day and eat a VERY healthy diet. (Lots of fish, fruit, red meat!) I am proud of the changes I have made, but am now scared that the damage is done. I knew I shouldn't smoke and made that decision on my own, however, I had NO idea about the high level of radiation I was being exposed to as I took the tests that my doctors ordered for the past 20 years.

I know you can't give exacts, but how much have these tests increased my chances of getting cancer? Would it be prudent to do MRIs every three years old patientalong with cystoscopy and cytology instead of CT Scans?

I am so shocked and scared of what I just found out. I have two teenage daughters and a wonderful husband and I want to be around for a long time to come. I feel like I've actually increased my chances of urological cancer with all of these tests, rather than protecting myself.

Can you give me any information to help me understand what I may have done to myself and what, if anything, I can do to continue to take better care of myself? I am only 42 and I am terrified that I've done irreparable damage. My PCP said that when I quit smoking 4 years old patientago, my risk started going down immediately for cancer. Also, just an aside, should I be concerned about the calcification on my lung, despite my PCP, Radiologist and Urologist saying that it is totally benign and needs no follow up? Goodness knows, I don't want to have anymore imaging tests in the future unless they are absolutely necessary. I don't think a lung CT is necessary.

I think I'm just looking for some reassurance. I'm really beating myself up for my smoking history. I feel so scared and ashamed. Thank you so much for your help. I appreciate it!

Sincerely, Robin

Category: Urologist

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Category: Sexually Transmitted Diseases(STD)Specialist
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Hello Robin.
Thank you for your query at

It is great that you have quit smoking. Quitting has lowered your
chances but they still do exist. But the first positive step that needed to be taken and which most people fail to do, you have succeded and hence the chances have been significantly lowered.
Total radiation exposure involved in ct urogram can be safely
administered every year without increasing your chances of getting
cancer. There have been lots of studies but conclusive evidence is lacking about the increased risk of cancer from such radiation exposure. In CT urogram it is slightly higher definitely, but a lot of patients have been advised yearly CT urogram based on their conditions, and they have not shown any signs of cancer. It is theoretically possible, but practially i am yet to come across a case like that.

Calcified granuloma can be normally seen in normal individuals and you
should stop worrying about it.
Hope this was helpful,

Take care

Patient replied :

Thank you so much for your answer. You've definitely eased my mind. As I understand it, I do not need to follow up on the granuloma with any additional scans since the doctor was absolutely sure of what it was. One final question. It's more general. Is it normal for your blood values to bounce around? My doctor has started sending me a copy of my blood/lab tests and I've noticed that sometimes, I am at the high end of the range and sometimes, the opposite, within just a few months of eachother. For example, my white count was 4.1 (which is normal according to her lab, but on the low end) but a few months before that, it had been at 7.7. Specifically, I am wondering why my rbc count is at the top of normal according to the lab. My red blood cells are 4.86 and that is actually at the very TOP of the range. The final thing I noticed is that a couple of months ago, my calcium level went as high as 10.1. It's now at 9.8. All of these numbers are within normal range, but are either at the very TOP of it or the very BOTTOM of it according to my lab. I struggle with Generalized Anxiety Disorder and I think this is why I have been panicing over health issues as of recent. I've had a lot of doctor's appointments and have really been on edge. I just wanted to be sure that these numbers weren't indicative of cancer or any other disease. Thanks for answering my questions.....I appreciate it! Robin

Thank you for the follow up.
Yes, it is absolutely normal for the blood parameters to be different at various times, in fact it can vary at different points in the same day. If it is in the normal range then there is nothing to worry about. We really don't give any importance to whether it is on the higher side of normal, or in the lower side of normal.
It is the same with calcium too. It all depends on the physiology of the body cells, how much vitamin d is the body getting, and in return how much calcium is it allowing to be formed.
In a nutshell, it can vary and that is absolutely normal. It is no way indicative of cancer.
Hope this was helpful,

Patient replied :

Thank you so much for all of your help and comforting answers. I have one last question, and then I promise to close out this discussion. Like I told you before, my anxiety has really been up lately, and my mind has been all over the place with regards to medical issues. SO.....I'll tell you really quickly what has gone on in the past 6 months, and I think you'll understand a bit of my anxiety.
February: Fell down our hardwood stairs from the very top and landed at the bottom on my head. Was conscious, but unresponsive. Didn't know who I was, my birthday, my family, etc... I do remember a blip of a moment of being in the ambulance on the way to the hospital and absolutely nothing of an 8 hour stay at the hospital. One of the reasons for me being nervous about radiation, is that during a period of two days (I had to go back the next days for significant side effects), I had a chest x-ray, a cervical spine CT and two head CTs.
March: Found out that hospital tests revealed blood tests of high liver enzymes. Went to my PCP who sent me to get my liver ultrusounded and it showed moderate to severe fatty liver. (I am a recovering alcoholic....have been sober for over 7 years, so this was not related to alcohol use.) Instead, my doctor said it was related to my weight, which had gotten up to 190 pounds. I am 5 feet 5 inches and that was considered obese for me. Since March, I have been walking 5 miles a day and eat a VERY healthy diet. It took about 4 months, but my liver enzymes came down and are totally normal. My weight is also 60 pounds. I am at 130 pounds, YAY! During the midst of all of this, my doctor said that high liver enzymes and a fatty liver show a liver condition caused NASH and that it could progress to cirrhosis, liver failure, liver cancer and death. I was horrified. Since that time, I have talked to NUMEROUS doctors, including my PCP who say that they think this was a total misdiagnosis. I had just started a new medication before I fell a few weeks before, and that was what caused the fall due to a drop in my blood pressure. I was on it for a few more weeks before I quit taking it and my enzymes kept going up. As soon as I went off the medication, they started coming down. Like I said, I also have been exercising and eating right and losing weight, so who knows exactly what was going on. I just know that I have another liver enzyme check in January and probably another scan not long after that to make sure that the fat is disipating.
June: After 2 months of irregular, crazy, long, short, you name it periods, my doctor decided to do a hysterectomy but to leave my ovaries. Found a polyp and some other benign findings in pathology, but otherwise all good. Another scary time.....
July: 2 suspicious skin biopsies that turned out to be nothing.
August: Colonoscopy with three precancerous polyps. (I've had them before, so I know that I'll be okay as long as I keep on following up.)
August: Urogram with WEIRD finding of calcified pulmonary granuloma! As a former smoker, I was sure it was cancer.
At that time, a friend mentioned to me that I'd had a lot of CT scans this year and that they are a definite cancer risk. It totally freaked me out.
I have calculated all of the CT tests I've ever had, including three IVPs in my 20s and 30s.
My total medical mSv radiation accumulation over the 42 years old patientof my life is 55. Is this a huge number? From now on, I think I may ask for ultrasounds and/or MRIs as to avoid any further radiation. I feel like that is a lot for a 42 year old female.
So, as promised, my last question. How much does 55mSv raise my cancer risk? Most of the radiation (35mSv) has been since I was over 40. I'd really love to hear your opionion. I'm just so scared with the smoking history and the radiation exposure. I want to put this all behind me and get on with living a happy, carefree life. I want to enjoy my wonderful hubby and children and right now, I am worrying so much, that I just can't seem to do that. I am seeing a counselor for this. I started seeing her about a month ago and it seems to be helping.
Thank you again for all of your comforting knowledge.
Sincerely, Robin

Dear Robin,

It is good to hear that you have recovered from such a terrifying incident. Your worries are not unwarranted.

Excessive radiation exposure can cause cancer but usually if the exposure is less than 50mSV in a single year then the chances are very minimal, practically nil. Your accumulated exposure is definitely much less than that.

Stop worrying; move on with your life and limit exposure in future.

Let me know if I can assist you any further.
Take Care.

Dr Rajiv Goel,
Consultant Urologist.

Dr. Rajiv Goel
Category: Sexually Transmitted Diseases(STD)Specialist
MCh(urology) Medical Council of India
Fellow, Laparoscopic urology, Germany
Fellow, Urooncology and Robotic urology, Australia
Felloship - MCH, Urology/Genito-Urinary Surgery, AIIMS, 2004
Residency - MS, Master of Surgery, AIIMS, 2001
Medical School - MBBS, Bachelor of Medicine and Bachelor of Surgery, AIIMS, 1998
Dr. Rajiv Goel and 4 other Medical Specialists are ready to help you

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