Contrast dye for angiogram, need advice

Discussion in 'Fibromyalgia Main Forum' started by kooky, Jul 1, 2008.

  1. kooky

    kooky New Member

    ARe there any herbs or supplements that can reduce the toxicity of contrast dye?

    I already suffer from heart failure, borderline kidney failure, and hypothyroidism. all three are contraindicated for contrast dye.

    I also have other health issues, including difficulties with metabolizing pharmaceuticals.

    I have till tomorrow to decide if I will go ahead with having an angiogram which means using a contrast dye.

    Contrast dye are known to cause kidney failure, strokes, MI, life threatening hypoglycaemic attacks (yes, had this too). and more health problems.

    IN this case, it is having to weigh the benefits against the side effects. I haven't made up my mind yet if I should go ahead or not.

    Any feedback on which herbs or supps to avoid toxicity from the contrast dye would be appreciated. And of course, your own experience with contast dye.

    Many thanks
  2. JewelRA

    JewelRA New Member

    I didn't know that contrast dye was known to cause all those things! I DID know that it could affect your thyroid function.

    And I know that last fall when I had contrast dye for a CT scan, I felt BERSERK for several days afterward!!! It was really scary, especially that my doctor and none of the radiology personel knew anything about such a reaction! Grrrrr....

    I wish I could help you with some things that might counteract the toxicity of it, I just don't know anything. I hope someone else on here does.

    Good luck with your decision! It sure is tought, isn't it?
  3. tansy

    tansy New Member

    Hi Kooky

    I cannot have the iodine based dye since it sent me into anaphylactic shock. Though this amino acid can help protect the kidneys from iodine based dye it does not suit me either; but others have taken it without ill effect. RichvanK explained some time ago why NAC may have caused me problems; since it is relevant to his hypothesis on the methylation pathways.

    Good luck I know what it's like in the UK; mostly we're left to fend for ourselves. I ended up self treating my cardiac symptoms with the Sinatra/Myhill supps to support mitochondrial function (minus the d ribose) and hawthorn.

    tc, Tansy


    N-acetylcysteine beats other meds at fighting common scan side effect
    By Owen Dyer

    Patients with impaired renal function should not accept a CT scan unless they are first given a pill to protect their kidneys, say researchers writing in the February 19 issue of the Annals of Internal Medicine.

    Even patients with healthy kidneys could benefit from taking the nephroprotective drug N-acetylcysteine, also known as NAC or acetylcysteine, before undergoing scans involving iodine-based radio-contrast agents, the study finds. N-acetylcysteine is cheap, safe, widely available, and could prevent serious kidney damage often caused by iodine.

    The use of contrast agents has brought enormous medical benefits, especially in angioplastic surgery, but has also heralded a steep rise in kidney failure, by far the most common and serious side effect of powerful scanners. As many as one in ten healthy people undergoing CT scans suffer acute kidney failure — an increase of at least 50% in blood creatinine — typically peaking two to five days after exposure. Patients considered at-risk for kidney problems fare worse — about one in four suffer mild to moderate kidney damage. A Danish study in 2003 identified contrast media assisted x-ray as the third leading cause of hospital-acquired acute renal failure.

    Various approaches have been tried to ameliorate this problem, hydration being the commonest. But hydration alone is often not enough. A whole battery of drugs have been tried, including N-acetylcysteine, theophylline, fenoldopam, bicarbonate, dopamine, iloprost, statins, furosemide, and mannitol. Each has had its advocates, and some have shown efficacy in trials. But the research is skimpy, the studies are small and these options have rarely been compared head-to-head.

    The answer for such circumstances is a meta-analysis, and that has now been performed by researchers from the University of Michigan Health System. They compared 41 studies involving 3622 patients. Their conclusion will please any radiologist on a tight budget — humble N-acetylcysteine, at about 25 cents for a 500mg tablet or two dollars for a 48-hour prophylactic course (Canadian prices run in the same range), was the clear winner. Relative risk of contrast-induced nephropathy, defined as a 25% increase in serum creatinine, was 0.62 for patients who took this drug.

    "This drug, which is quick, convenient, inexpensive and widely available, with no major side effects, appears to be the best choice to protect those whose kidneys are most at risk," says lead author radiologist Dr Aine Kelly.

    In fact, theophylline beat that result slightly, with a relative risk of 0.49, but the data supporting this finding was much weaker, and the 95% confidence intervals even allowed the possibility of some increased kidney risk. The other drugs studied — fenoldopam, dopamine, iloprost, statin, furosemide, and mannitol — mostly had no effect, except furosemide, which was found to sharply increase danger to the kidney, with a relative risk of 3.27.

    None of the findings in this study apply to contrast mediums that don't contain iodine, like barium enemas, or the gadolinium contrast agents used with MRI scan, typically in multiple sclerosis. A few centres offer low-iodine or no-iodine contrast agents with CT scan, but it's expensive and generally reserved for those with known kidney problems.

    N-acetylcysteine is generally used as a mucolytic, and also as a treatment for acetaminophen overdose. Any facility sophisticated enough to offer radio-contrast x-rays should have some handy. It can be had as a supplement, boasting clinical effects similar to mugwort, but these formulations are useless for kidney protection, the Michigan researchers warn.
    [This Message was Edited on 07/01/2008]
  4. tansy

    tansy New Member

    Many People Should Take Inexpensive Drug To Protect Kidneys
    ScienceDaily (Feb. 20, 2008)

    As more and more Americans undergo CT scans and other medical imaging scans involving intense X-rays, a new study suggests that many of them should take a pre-scan drug that could protect their kidneys from damage.

    The inexpensive drug, called N-acetylcysteine, can prevent serious kidney damage that can be caused by the iodine-containing "dyes" that doctors use to enhance the quality of such scans.

    That "dye," called contrast agent, is usually given intravenously before a CT scan, angiogram or other test. But the new study shows that taking an N-acetylcysteine tablet before receiving the contrast agent can protect patients -- and that it works better than other medicines that have been proposed for the same purpose.

    People whose kidneys are already vulnerable, including many older people and those with diabetes or heart failure, are the most at risk from contrast agents, and have the most to gain from taking the drug.

    Researchers from the University of Michigan Health System performed the study, which is published in the Annals of Internal Medicine. It is a meta-analysis of data from 41 randomized controlled studies that evaluated various drugs for their kidney-protecting effects. It was led by Aine Kelly, M.D., M.S., an assistant professor in the Department of Radiology at the U-M Medical School.

    Only N-acetylcysteine clearly prevented contrast-induced nephropathy, the medical name for kidney damage caused by contrast agents. Theophylline, another drug that has been seen as a possible kidney-protecting agent, did not reduce risk significantly. Other drugs had no effect, and one, furosemide, raised kidney risk.

    "Our goal is to improve the safety and quality of these common tests by studying drugs that reduce the risk of kidney failure," says senior author Ruth Carlos, M.D., associate professor of radiology.

    Mild to moderate kidney damage occurs in one in four high-risk people who have CT scans, and in as many as one in ten people with normal kidney function. In some cases, it causes acute kidney failure.

    "Millions of people receive contrast agent each year, including most heart patients who have angioplasties and stents, as well as those having a CT scan. Contrast agent helps physicians see the things we need to see, but it also does pose a hazard to some people," says Kelly. "This drug, which is quick, convenient, inexpensive and widely available, with no major side effects, appears to be the best choice to protect those whose kidneys are most at risk."

    Only studies that involved intravenous iodine-containing contrast agents, and compared a drug with a water or saline control, were included in the analysis. Oral "milkshake" barium contrast agents, used in CT scans of the digestive system, do not cause kidney damage, and were not included.

    The study also did not assess potential ways to protect against kidney damage from gadolinium contrast agents used in MRI (magnetic resonance imaging) scans. Since May 2007, those contrast agents have carried a warning from the U.S. Food and Drug Administration about risk to kidneys.

    Kelly, Carlos and their colleagues performed the study to try to get a firm answer to a question that has puzzle medical imaging specialists for years.

    Although many drugs have been tried for prevention of iodine-related contrast-induced nephropathy, contradictory evidence has emerged from studies of how well they work. The result has been widespread variation in what hospitals and medical imaging centers do before scanning a patient.

    Although a prospective trial comparing N-acetylcysteine directly to other drugs should be conducted to verify the U-M team's findings, the team hopes its new study will help guide both clinicians and patients.

    In fact, Kelly says, patients who know they have weakened kidneys -- also called impaired renal function -- should speak up when their doctor orders a CT scan, angiogram or angioplasty, and make sure they get a tablet of N-acetylcysteine beforehand.

    And, since most kidney problems cause no symptoms, even healthy people might want to ask their doctors to test their blood creatinine levels before sending them for a scan.

    Creatinine levels go up when the kidneys aren't operating efficiently. Contrast-induced nephropathy is defined as a 25 percent or greater increase in creatinine within 48 hours of receiving contrast agent. The new study evaluated the impact of pre-scan medicines by looking at their impact on patients' creatinine levels, as a surrogate for kidney function.

    The problem of contrast-induced nephropathy is a relatively recent one -- a byproduct of the dramatic increase in the use of CT scans and X-ray guided procedures such as angioplasty.

    The benefit of these scans is not in question: Intense X-rays can reveal valuable information about injuries, diseases, and patients' response to treatment. Iodine-containing agents allow doctors to improve the scans even further, giving better "contrast" between the blood vessels and tissue, because X-rays are scattered differently by iodine. But as the iodine is carried by the blood to the kidneys, and filtered out into the urine, the iodine can upset the delicate balance that keeps the kidneys functioning.

    In recent years, manufacturers of contrast agents have begun to offer different formulations that may pose less risk to patients' kidneys. More expensive low-iodine and iodine-free agents are available to especially vulnerable patients, and to people who are allergic to iodine. But for everyone else, medical imaging specialists have tried to find ways to prevent the damage.

    N-acetylcysteine is already widely used to clear mucus in cystic fibrosis patients, and to treat overdoses of acetaminophen. It's also being studied for other uses.

    Tablets of prescription-strength N-acetylcysteine are inexpensive -- about 25 cents for a 500 milligram tablet -- and stocked by most pharmacies. It has few side effects. Over-the-counter supplement forms of the drug should not be used for pre-scan kidney protection.

    In addition to Kelly and Carlos, the study's authors are Ben Dwamena, M.D., and Paul Cronin, M.B.B.Ch., both assistant professors of radiology, and Steven J. Bernstein, M.D., MPH, professor of internal medicine. The study was funded by the National Institutes of Health and the National Cancer Institute, and by Kelly's GE-Association of University Radiologists Radiology Research Academic Fellowship. None of the authors has financial connections with manufacturers of the drugs or contrast agents studied.

    Adapted from materials provided by University of Michigan Health System, via EurekAlert!, a service of AAAS.
  5. simonedb

    simonedb Member

    my friend just told me this to about ct angio
    I had one for head and neck when had some symptoms of a stroke (i was fine it turned out) had it about 2 years ago, I had no idea it was risky, i dont think they really empahsizd that.
    nothing bad happened but do you think it increased much my chance of cancr or kidney failure? is it known if it would likely increase a certain kind of cancer risk, and if kidneys made it thru ok are they probably over it or does it increase risks even years later?
  6. kooky

    kooky New Member

    Thanks for the info. In fact, I was in hospital today, but left without going ahead with the angiogram (and contrast dye).

    The young cardiologist offered to inject me with NAC, but I was not keen on that either.#

    Why could you not tolerate NAC? What does Rich says about some of us being unable to tolerate NAC??

    I would prefer to wait and sort out the kidneys first. I would like to know why my creatinine and GFR were abnormal and showed kidney dysfunction.

    The cardiologist despite his assurances, explained that some who are in fact much worse than myself, with renal failure, had the contrast dye.

    My reply is what happened to these people within the next two years?

    There was not reply....

    I decided to take a risk, and should I have an MI between now and seeing the nephrologist, so be it.

    It might sound foolish or hard headed, but I am just so ill, that I could not take more.

    Unfortunately, I have lost all trust in medicine, it is far too corrupt, and political.

    Thanks for you input.


  7. kooky

    kooky New Member

    Thanks for your feedback.

    I am afraid that I have no trust whatsoever in medicine. Before being injected with anything or swallowing anything, I research assiduously. I am far too ill and can't afford to worsen.

    I am aware of the risks here but thought it best to have the kidneys sorted out and the saphena varix before having the angiogram.

    Having said that, I will have to live the consequences, if I was to have an MI, in case, there is a blockage, and they could have inserted the shunt, but then, would have worsen with the contrast dye?

    Difficult decision as always.

    It might be a good idea for everyone to research before taking anything, even supplements and vitamins. We are so very sensitive, and have little understanding of the mechanism of what is happening to us.

  8. gapsych

    gapsych New Member

    If you take any over the counter drugs, please let your physician know before getting the CT.

    What does your doctor say?

    I had a slight reaction to contrast dye a long time ago. I got two hives on my face along the nerveline. It did not bother me that much. However, the doctor said to make sure this was put on my medical record. I did have another contrast dye several years later. They gave me benadryl and I was fine. However at the time I was not having any health problems.

    I think there are several kinds of contrast dyes but do not know if one is better than another for people with health problems.

    I am sure this has to be a very difficult decision to go through.

    Whatever you decide to do, good luck.

    Keep us posted.

    [This Message was Edited on 07/02/2008]