OpenHealth Q&A

Examining the Quality of Nuclear Medicine Bone Imaging Post-Paget’s Diagnosis: Does Location Matter?

I would like to revisit my earlier inquiry, having realized that sharing minimum patient information is essential. I genuinely appreciate any insights or suggestions from medical professionals regarding the situation. My husband, a 67-year-old male standing at 6'2" and weighing 220 pounds, has always maintained good physical fitness. He has been diagnosed with Type 2 Diabetes for the past 20 years, attributed to genetic predisposition rather than lifestyle choices, as he is Panamanian. His cholesterol level is 170, with a favorable ratio of good to bad cholesterol, and his blood pressure readings are within healthy limits. Currently, he is prescribed Metformin ER at 500 mg and Glyburide at 5 mg. Despite diligent efforts in managing diet and exercise, his A1C remains elevated at 7.8. His new endocrinologist has suggested the use of statins and weight-loss medication; however, we are apprehensive. Recent lab results indicate that everything is stable, except for an enlarged PSA, which requires a second opinion from a urologist at COH. Interestingly, his testosterone levels, which have been on the lower side for many years, are now at the normal range. Last year, he underwent a robotic-assisted partial nephrectomy at COH after being diagnosed with stage 1 kidney cancer, as confirmed by both Loma Linda and COH. Fortunately, the pathology report revealed it to be a benign oncocytoma, which is considered rare. I’m feeling uncertain about changing imaging facilities. Is the quality of Nuclear Medicine bone imaging (whole body) at Radnet in Riverside comparable to that at City of Hope in Irvine, CA? In previous MRI and CT scans related to his kidney issue, abnormal mottling was detected on his iliac crest, leading doctors to suspect Paget’s disease. He is currently consulting with an endocrinologist at COH in Irvine. The initial scan was requested at COH but due to traffic concerns and the additional out-of-pocket expense exceeding $500, I opted to switch to Radnet. Now I am apprehensive about whether the quality will match what we would have received at COH. Additionally, I am troubled by the rapid decline in his muscularity over the past year and a half. His internist and primary care physician have pointed out the natural muscle loss that occurs with age, but I feel they underestimate his history. His traps were impressively large even during periods of inactivity, and his biceps used to rival the size of my head. However, he has transitioned from an extremely muscular XXL to a size L, and this quick thinning of his physique raises red flags for me. His leg muscles, in particular, are smaller than mine despite my own active lifestyle. While I am grateful that cancer was ruled out, the noticeable decline in his musculature indicates to me that something might be awry. At least he is now being actively monitored by doctors at COH for both the prostate and Paget’s condition. Thank you once again for your understanding and guidance.

Answers (1)

8/26/2025, 12:42:18 AM

OpenHealth AI

Main Points: Your concerns focus on the quality of imaging facilities for evaluating potential Paget's disease in your husband, as well as the significant muscle loss he's experienced. It's essential to weigh the similarity in imaging quality between locations and address the rapid muscular decline.

Explanation: The quality of nuclear medicine imaging can vary among facilities, but both Radnet in Riverside and City of Hope generally maintain high standards for diagnostic imaging. Factors influencing imaging quality include the equipment used, the experience of the technicians, and the interpretation of results by nuclear medicine specialists.

Regarding your husband’s muscular decline, this can be influenced by several factors including aging, lack of physical activity, hormonal changes, and underlying medical issues. Notably, significant muscle loss (also called muscle wasting or cachexia) can sometimes indicate health problems that warrant further evaluation.

Next Steps:

1. Consider Quality of Imaging:

   • Check with both Radnet and City of Hope about the specific technology and protocols they use for nuclear medicine bone imaging. You may find that Radnet has comparable equipment. If cost is a major factor, you can discuss this directly with your husband's healthcare provider to determine if a referral back to COH is critical for this particular imaging.

2. Monitor Muscle Changes:

   • Document any further observations regarding his muscle size, strength, and energy levels. This log can provide important insights when discussing concerns with his medical team.
   • Encourage gentle strength training or resistance exercises if appropriate and approved by his healthcare providers to help with muscle retention.

3. Follow Up on Hormonal Factors:

   • Since testosterone levels have normalized, discuss with his endocrinologist if this might correlate with increased muscle mass. Beyond hormones, nutritional factors should be reviewed—ensure he is consuming adequate protein and calories.

4. Address A1C and Medication Options:

   • Since his A1C remains elevated, review his current medications and dietary regimen with his endocrinologist. While some may recommend statins and weight-loss medications, it’s essential to understand their implications on his overall health, especially considering his cancer history and other medications.

5. Keep the Dialogue Open:

   • Continue discussing any changes you notice with both his primary care physician and specialists. They can provide reassurance and adjustments as needed based on ongoing evaluations.

Your proactive approach and willingness to seek answers for your husband’s health are commendable. If concerns persist, never hesitate to advocate for further evaluations or a second opinion from healthcare professionals.