DAT scan and Wellbutrin

[Boomercd]

I have called the hospital 4 times now talking to the same tech, I was hoping for someone else but this tech tells me I can take my meds ...I'm on Wellbutrin and still have the DAT scan I don't think so! I also called my neurologist his nurse said do what the hospital tells me to the problem is I have to pay almost 2 grand out of pocket for the test and i would like it to be accurate Im a nurse and it doesn't make sense to me how you could take a dopamine reuptake inhibitor and the test be accurate. I'm going to try tomorrow morning again if they can't explain it to me Im going to cancel until someone can. Anyone else had the scan on Wellbutrin?

[MarionP]

I wouldn't trust the way you've been handled. But I don't trust anybody who isn't forthright and willing to point me toward alternative sources of information so that I have a basis for knowing what's going on, second opinions and be able to go to a higher authority. Justification and explanation is part of informed consent, if it hasn't been fully justified and your questions satisfied, even if they came up late, then it is NOT informed consent. YOU'RE A NURSE SO OF COURSE YOU SHOULD KNOW THAT, AND BE WILLING TO EXPECT THAT YOU GET THE SAME HANDLING WHEN YOU ARE A PATIENT.

Sounds like your question is a reasonable one. You have a right to be fully informed as a condition of your consent.In any case whatever is done therapeutically is still going to be determined, experimented, titrated, clinically by trials and error in any case. $2,000 is a lot to waste out of my pocket and anybody who wasn't going to appreciate it or respect it hasn't done their job until my gut tells me otherwise.

Maybe they think because you are a nurse, the nurse at your doctor's office will think you're used to being told no and taking it and shutting up, leaving you to helplessly fret in the dark. Or maybe as a nurse, you're ordering doctor's nurse figures you're used to that so when you called and that nurse said do what the hospital says, maybe she was thinking well this is just a stupid patient and you know my job is to get them to do what we told them, not answer their questions... If that's all she practices as a nurse I would drop hints about talking to the state nurse licensing board... Maybe she is just testing you to see if you'll give up easy and go away... and if you are uncomfortable speaking up for yourself and being willing to stop the procedure... well, you deserve better than that from your medical care practitioners. I hope you don't think that's the way to practice nursing yourself.

But I'm paranoid and I am blunt, very partial and I'm a hypercritical shopper. I have no problem making people prove that they're on my side and that they give a crap. At the very least I'd challenge to satisfy you exactly how they know and whether they're willing to put it in writing and sign it. Tech operation isn't the same as interpretation...And a nurse who is too quickly dismissive of their patient isn't a nurse, despite what it might say on the wall. Too bad she doesn't want to bother the doctor or have to spend more time with you.

I recently did a hard challenge exactly on that point, just like your situation actually only was an MRI, a possible confounding chemical question that just came up, on the table with a MRI brain scan and would not let them proceed until I was satisfied, all of my questions answered. Not my fault nobody ever bothered to ask me if I had questions or was willing to answer my questions if a new one came up on the spot on the table. The tech was eager to say whatever it took to get me to stay on the table, you know, your doctor ordered this and he knows what he's doing blah blah, but that was a dismissive tactic and evasive and I told him so... and I told him he can get his hands off of me until I am satisfied... And that was at the Great Mayo Clinic (the scanner itself was in the hospital).

I remember saying once or twice "sorry that's not good enough and if you can't give me an answer you're going to have to get people who can and who are competent to be challenged on the matter." They weren't used to it but I said "It's my body and my consent and my money, if it's not INFORMED consent then we'll stop right now because I am withdrawing that consent until I get a reasonable answer." The thing is really it should not be scheduled until all of your questions have been answered by the people who ordered it, but this one slip through and that was because other people were involved not just me, and provision wasn't made for questions that come up late since you can't think of everything, after all you're not the doctor, so if they don't prepare and educate you enough prior to pulling the switch that cannot be your fault, you're the patient and you aren't required to know better, they are, comes with the territory and scope of practice. Anticipation is part of the job they're supposed to be doing competently. And that includes the the people who are setting it up.

If you have been bums rushed through the referral and question and answer process, and the tech isn't willing to pause and help find a way to get your recent question addressed to your satisfaction, well I am generally much more assertive... and that starts with the doctor face-to-face recommending and wanting the referrals to happen, and the kind of question you ask really is beyond what is reasonable to expect of a tech.

Maybe because you are a nurse you find it difficult to get in a fellow nurse's, or the doctor's face. Or people just think that of you, or are testing you to see if you will give up and shut up...or maybe they think that of all the patients. But you have a right to be treated just like that doctor would treat his own mother and to make it known if they don't do that, before you are committed. Ask every person involved if they are going to be willing to personally dig into their own pocket and refund you if this thing is f***** up and ask them if they're willing to put every reassurance and guarantee and dismissal they make in writing and sign it and get their boss to co-sign. But that's just me, everyone has to operate the way they see fit.

[Boomercd in reply to MarionP]

Thank you

[ottercat]

I just had a DaTscan, and was told that the dopamine-encouraging supplements (mucuna pruriens and l-tyrosine) I take that have helped control tremor over the last 6 years would not be a problem. The scan still revealed the following:

Moderate to severe decreased radiotracer uptake within both putamina, suggesting nigrostriatal degeneration.

Granted it is not Wellbutrin--but perhaps the principle applies?

[Boomercd in reply to ottercat]

Thank you

[ottercat in reply to Boomercd]

Good for you, for sticking to your guns~ You're so right--they need to add buproprion to the list of instructions. And to listen to the patient. Very best wishes to you.

[Boomercd]

I have already cancelled the Scan for now Dr finally called turns out I was right and I need to be off Wellbutrin for 7 days before the scan but now I'm worried about the other patients without medical experience who have been in my same situation the hospital says it's not their fault the Dr says it's the hospitals fault. Doesn't really matter I'm going to find a hospital to do the scan that I feel is competent to do so

[MarionP in reply to Boomercd]

Absolutely right, and your doctors attitude that the hospital is at fault is actually an example of poor physician process because in doing so he opens a gap for error to fall through and even be encouraged, leading possibly to a wrong diagnosis which then will further confuse diagnostic efforts downstream, in medical school they call this a training game called "bait and switch," in which medical students and interns are challenged deliberately by adding errors to a clinical presentation and then on the basis of the incomplete or mass information ordering an inappropriate treatment that both fails to address the original problem and also adds new problems from the flawed treatment, then the cases switched over to a new naive doctor for the second round and then the doctor is challenged to unravel and diagnose two conditions and consequences produced by physician error... it's all a testing game. the idea is that leads the examiner to make a flawed diagnosis, and then prescribe and equivalently erroneous treatment, which then causes new side effects because it is not appropriate and treating something that doesn't exist but imposes its own consequences on the person's system, well the original problem grows more severe for having not been identified in the first place, and then that patient is swapped to a new naive med student or intern doctor to see if that second doctor will be able to do anything, now having had more problems by the first doctor (called "iatrogenic" or "doctor-caused") added to the case presentation. The whole idea is to show that case presentations can be complicated and error along the way makes it even harder and worse, with higher and higher stakes and risks with each passing misdiagnosis and mistreatment, including failure to treat the originally underlying original presenting case. (I had to pass challenges like this when I was in my internships to be a psychologist.)

By the way this exact process in its entirety was made the basis for entire medical drama TV series called House, in which each episode featured a brand new example of the exact same game process.

It is also the reason why doctors professional liability premiums (i.e., "malpractice insurance") are often very high and hospitals have staff attorneys with round-the-clock hours.

Maybe you should show this entry here to your doctor. And that nurse. And the executive administrator and The clinical director of the hospital. And the original producers and writers of the House TV series to see if they think maybe the market might support a new version of House, obviously some people fail to get the memo about the original series. Maybe you'll get a finder's fee.

[Daisies22 in reply to Boomercd]

I just found this paper, and yes you were right about the results of Dat scan being affected by wellbutrin (also known as bupropion)

"In 2008, we recommended withdrawing the antidepressant bupropion when a patient is referred for DAT imaging [5]. Bupropion is frequently prescribed as an antidepressant or as an antismoking drug"

link.springer.com/article/1....

D

[ottercat in reply to Boomercd]

Just reviewed the printed directions from my local hospital system and from GE Health (manufacturers of the DaTscan machinery): both of these specified that buproprion should be discontinued for several days prior to the scan. I'm amazed/apalled that your hospital didn't provide such a list. So sorry.

[Boomercd in reply to ottercat]

Maybe this will cause the change.