Topic: Things to know about Dr. Google. Number 75 will shock you !!

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Mar 26, 2019 09:22AM - edited Mar 29, 2019 01:23PM by djmammo

Posted on: Mar 26, 2019 09:22AM - edited Mar 29, 2019 01:23PM by djmammo

djmammo wrote:

There is no #75. There is nothing here to shock you. Don't you hate "click bait"?


HERE is a reasonable article from Reader's Digest on the subject of researching your symptoms on line.


=======================EDITORIAL==============

I will add the following caveats that you may not see printed elsewhere as they are my personal opinions based on personal experience over the years:

A very large part of a medical education, besides learning all the rules of diagnosis, is learning all the exceptions to all the rules and their relative likelihood. Some things that appear to be benign on initial evaluation may be malignant, and the reverse is also true. An online article in a lay publication in order to be more interesting* may present a limited mix of those exceptions without a proper explanation of how often they occur in nature. Plus their goal is to pull in more readers and that can't happen if they dont include some sensational bits of information that could kill you. A medically related article in a lay publication would be boring if no one was born with a goat's head coming out of their ear.

Also, in order to avoid liability, an online publication will have to include the worst possible disease associated with any set of symptoms, no matter how rare, so that no one dies and has their family sue them for a substantial sum because the web site said "don't worry about it". Be prepared to be presented with worst case scenarios in bold type even if those scenarios are extremely rare or one of a kind. My chairman in residency, when someone would bring up such an unlikely diagnosis during a conference, would say (and I'm paraphrasing) "There has also been a case report of an immaculate conception but its not he first thing we think of".

I have been criticized for criticizing on line searching for medical advice in order to arrive at a diagnosis on one's own and that's fine with me. There are those that defend it vehemently citing the importance of being proactive and that one must be an active participant in one's healthcare, and I agree with all of them whole heartedly when it comes to disease management. However, prior to a tissue diagnosis, it seems I hear more people complain about the fear and panic generated by this practice than anything else. Also, not everybody's gut feeling is correct.

These searches are reasonable for the 'classics' like right upper quadrant pain after eating, leg pain after walking, shortness or breast going up stairs and other symptoms where the purpose of the article is to get you to see a doctor. It becomes more problematic when you have already seen a doctor and you are searching for specific x-ray findings to determine which particular type of a dozen different types of calcification is present in your breast.

The alternative to searching lay publications is searching the medical literature. Medical journals are "refereed" or" peer reviewed": "Peer review or refereed journal is an academic term for quality control. Each article published in a peer-reviewed journal was closely examined by a panel of reviewers who are experts on the article's topic." The information here is more likely true and correct. This does not happen at Vanity Fair.

But there is also a downside to reading these medical articles and that is, like mammogram reports, they are written for physicians and not for the general public. In order to understand them properly, one must be familiar with the vocabulary and underlying medical concepts of the subject at hand. Misunderstanding any word or statement can change the meaning of the article completely and either create havoc or a false sense of security neither of which is helpful.

IMO, the most consistent benefit of Googling is preparing a list of questions to ask your doctor(s).


*Recall the scene from 'The Big Chill' where Jeff Goldblum's character describes writing for People Magazine.

Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 26, 2019 09:49AM beaverntx wrote:

Thank you, djmammo. As a retired health care professional, I am selective about where I search for information on the web. The RD guides and your caveats basically describe my filters.

BTW, it wasn't the #75 that drew me but the title of the thread! Well done.

Diagnosed at age 77-- Oncotype 17, dealing with this bump in the road of life!!🎆 Dx 1/24/2018, IDC, Right, 2cm, Stage IB, Grade 3, 0/9 nodes, ER+/PR+, HER2- Dx 1/30/2018, DCIS, Right, <1cm, Stage 0 Surgery 1/30/2018 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel Radiation Therapy 3/11/2018 Whole breast: Breast Surgery 6/15/2018 Hormonal Therapy 6/19/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 26, 2019 09:50AM - edited Mar 26, 2019 09:50AM by beaverntx

This Post was deleted by beaverntx.
Diagnosed at age 77-- Oncotype 17, dealing with this bump in the road of life!!🎆 Dx 1/24/2018, IDC, Right, 2cm, Stage IB, Grade 3, 0/9 nodes, ER+/PR+, HER2- Dx 1/30/2018, DCIS, Right, <1cm, Stage 0 Surgery 1/30/2018 Lumpectomy; Lumpectomy (Right); Lymph node removal; Lymph node removal (Right): Sentinel Radiation Therapy 3/11/2018 Whole breast: Breast Surgery 6/15/2018 Hormonal Therapy 6/19/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Mar 26, 2019 10:32AM Lexica wrote:

This is great, DJ Mammo - thanks :)

Diagnosed at 34. 2 years of Ibrance via PALLAS trial (ends 4/2020) Dx 7/2017, IDC, Left, Stage IIIC, Grade 2, ER+/PR+, HER2-, Surgery 12/15/2017 Lymph node removal: Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right Dx 12/27/2017, DCIS/IDC, Left, 6cm+, Stage IIIA, Grade 3, 5/11 nodes, ER+/PR+, HER2-, Radiation Therapy 1/16/2018 Whole breast: Breast, Lymph nodes, Chest wall Chemotherapy AC + T (Taxol) Hormonal Therapy Aromasin (exemestane)
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Mar 26, 2019 10:36AM cecyc wrote:

Djmammo,

Thank you for this.  It is so true. Especially when you can get in to see a Doctor right away and you want answers yesterday.   It is so easy to get sucked up in to believing everything you read online.  

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Mar 26, 2019 10:47AM MsRukia wrote:

DJmamo

I have a question. One doc said my lesion was not acting like a benign growth. Another doc said she was certain it would come back as benign. When I looked at it on the ultrasound screen it was not perfectly oval. It has edges on the end that stuck out. Is it possible to have a benign Fibroadenoma that has edges that stick out? I’m just curious what your take on it is

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Mar 26, 2019 10:48AM MsRukia wrote:

Oh and thank you for this post

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Mar 26, 2019 11:01AM santabarbarian wrote:

My personal approach is to limit the dates of the search to the last year or two, and to only put stock in medical, peer-reviewed literature.

But Dr Google was how I found out about melatonin and Metformin, both of which I am on with my MO's hearty approval, as well as the current trend towards taking fewer nodes, and sometimes not even doing lumpectomy surgery after imaging shows a pCR-- which, when I brought it up with BS, allowed me to save all but 4 of my level one and two nodes (which she was poised to take).

Dr Google let me in on Proton Radiation (which I just got), and provided a list of the less-metastatic anesthesiology drugs that I talked over w anesthesiologist prior to my surgery. It gave me info on Hyperbaric Oxygen and High Dose C and hyperthermia (heat) being cancer-killers, all of which I elected to use after informing myself. Also, a keto diet (with emphasis on vegan whole foods and fish, lower in animal fat). Last Dr Google told me a brief fast prior to chemo *might* lower my SEs and boost my response, as it does in mice (human trial in progress now).

These were all significant parts of my treatment, that I advocated for or asked about, that my team approved. Had I not been Googling like a MF, I would not have asked the right questions and **none of this** would have been suggested to me. TNBC is a nasty cancer and I am glad for bringing in these other practices, alongside the chemo. I only had 30% odds of a pCR.... and I got one. Now I have 90% odds of staying well. If I did not vanquish the cancer, or If I should progress later, I want to be able to look my kids in the eye and say, I did absolutely everything I could do to benefit me-- I did my very best to live.

pCR after neoadjuvant chemo w/ integrative practices; Proton rads. Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- Chemotherapy 8/13/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy; Lumpectomy (Left) Radiation Therapy 2/11/2019 Whole breast: Breast, Lymph nodes
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Mar 26, 2019 11:06AM djmammo wrote:

MsRukia

Well, you have three opinions in your post from which to choose but which one should you believe? The one with the most experience looking at masses on an US screen since FA's can have a variable appearance on US.

It may help you to decide by the facility in which they practice, a GP's office vs. a Breast Center. You can decide by the age of the doc, i.e. are they just out of training or do they have 30 years experience?

One thing that I do recommend Googling, is your doctor. Most of the time you can find how and where they were educated, what schools they attended, what residency they completed, if they did a fellowship in the area of your particular problem, and how long they have been practicing. It also matters how they define their practice e.g. general radiologist vs. full time breast imager.

Let us know what it turns out to be.


Board Certified Diagnostic Radiologist specializing in Breast Imaging. Contact me at DJMammo@gmail.com
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Mar 26, 2019 11:09AM santabarbarian wrote:

PS When I came to my first MO appointment and asked "which of the six subtypes of TNBC do you think I have?" he immediately re-classified me into the category of "well-informed patient" and he NEVER talked down to me, which I think benefitted me too. My BS told the tumor board that I was a vey well informed patient and that's why they approved her taking fewer nodes-- because I had done my homework on that and was able to give informed consent. (I agreed that if there was not a pCR, she could go back and take all the nodes).

pCR after neoadjuvant chemo w/ integrative practices; Proton rads. Dx 7/13/2018, IDC, Left, 3cm, Stage IIB, Grade 3, ER-/PR-, HER2- Chemotherapy 8/13/2018 Carboplatin (Paraplatin), Taxotere (docetaxel) Surgery 12/27/2018 Lumpectomy; Lumpectomy (Left) Radiation Therapy 2/11/2019 Whole breast: Breast, Lymph nodes
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Mar 26, 2019 11:22AM MsRukia wrote:

Thank DJmamo

The first doc has been in practice for forever. When I looked him up it didn’t have any negative reviews. The second doc who did my biopsy said he was old school. She said she specializes in breast care.


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