Saturday, October 4, 2014

Ebola, And Gil Mobley: Editorial

I know Gil Mobley.  He is a good person.  He is a great physician who does great work.  He has been in the news for donning a TYVEK suit and walking through Atlanta's Harts field airport.  I know him from some work we did together in Guatemala.  I think his comments are correct about the CDC.  His antics are a wake up call.  Gil Mobley is an intelligent doctor, and he spoke his heart.  I work in education, and patient care.  We should all wake up to his clarion call, and realize this virus takes no prisoners.  Gil Mobley was one of my students.  I taught him basic ultrasound skills in Houston Texas.  Gil, God Bless you if you see this post after the media frenzies.   TJW  Here are some links:

PHILADELPHIA (CBS) – Dom Giordano talked with Dr. Gil Mobley, who believes the CDC is lying about the threat posed by Ebola and staged a protest at Atlanta’s Hartsfield-Jackson Airport to expose it.

Thanks CBS and Dom Giorino

Credits:  
http://philadelphia.cbslocal.com/2014/10/03/missouri-doctor-its-just-a-matter-of-time-before-ebola-is-carried-to-every-corner-of-the-world/


 

Cardiologists Who Use An Ultrasound Machine To Examine A Patient?

It is Saturday.  My wife and I are sharing our twentieth wedding anniversary by going out for dinner.  I was cruising through all the doom and gloom of Ebola, and other stuff, and discovered a notable.  A cardiologist using an ultrasound machine to check on a patients heart.  When most patients come to the cardiologists come to the office, they get an ECG (EKG), and the usual vitals by the nurse.

I think that it would be great if a cardiologist TRAINED in BASIC echocardiography would use the machine to take a look at the patients heart.  A basic echo would assess cardiac output, wall motion, and other factors like valvular incompetency.  The machine to the left is not an ad.  It is one of several machines used in offices around the globe.  I think the cardiologist should use this tool in a BASIC examination of the patient in the office.  Question: reimbursement.  Oboma care?    We will see how that shakes out.  Here is a link to a useful article.

Cardiologists who used a handheld ultrasound were more likely to make an accurate diagnosis of patients with common cardiovascular abnormalities than colleagues who relied on a physical exam, for an estimated savings of $63 per patient. Handheld ultrasound’s ability to rule out abnormalities also likely would reduce downstream testing, according to a study published online Sept. 17 in the Journal of the American College of Cardiology: Cardiovascular Imaging. 

Thank you Sonoworld and Cardiovascular Business

http://www.cardiovascularbusiness.com/topics/imaging/handheld-ultrasound-trounces-physical-exams-accuracy-cost

 

Sunday, September 7, 2014

Thyroid Ultrasound: Always A Great Option

I do a lot of thyroid U/S.  Many people have thyroid issues.  The go to the doctor because of malaise, or feeling tired.  Perhaps they go to the doctor for a check up and the physician feels a lump in the neck.  Many people blame obesity on a thyroid condition.  I will stay away from that.  I do believe that Fine Needle Aspiration with U/S guidance is a great tool in dealing with thyroid conditions.  Personally, if a nodule is heterogeneous, non-compressible, and icky looking, it needs a FNA.  I had a patient last week who tested positive by ultrasound.  She has follicular cancer.  She will be OK  We caught it in time I hope.  Look at the above picture and remember this is a picture of a nasty cancer.

In the retrospective review, researchers evaluated data of 465 patients with differentiated thyroid cancer (DTC) who underwent surgery at Memorial Sloan Kettering Cancer Center between January 2009 and December 2010. Fifty percent of participants underwent preoperative ultrasound of cervical neck lymph nodes, and 231 were not imaged preoperatively with ultrasound. The median follow-up was 29 months. 

 http://www.healio.com/endocrinology/thyroid/news/online/%7Bb4868556-14b2-4e31-a48a-38169b9ce1f4%7D/preoperative-neck-ultrasound-led-to-better-response-fewer-recurrences-among-dtc-patients

Surgeons View Using HF Ultrasound To Detect Lung Cancer In The Chest Wall

It seems that something new and wonderful happens everyday.  This article I will post a link to is great news on the inventiveness of medical professionals all over the world.  We in the ultrasound community have known that high frequency, high definition medical ultrasound can create great pictures, and inspire inventive solutions to medical dilemmas.  In the case of cancer, it is a wonderful area of research, and development we are doing.  Lung cancer is one of the most nasty and prevalent cancers in the world.  Enjoy reading the link.

http://www.unboundmedicine.com/medline/citation/25038014/Preoperative_Assessment_of_Chest_Wall_Invasion_in_Non_Small_Cell_Lung_Cancer_Using_Surgeon_Performed_Ultrasound_


Preoperative Assessment of Chest Wall Invasion in Non-Small Cell Lung Cancer Using Surgeon-Performed Ultrasound.

Abstract

BACKGROUND
Chest wall invasion in operable lung cancer upgrades the stage and can affect operative planning. Diagnosing chest wall invasion preoperatively is important in patient consent, in the choice of operative incision placement, and can be helpful in choosing an operative approach (open vs thoracoscopic). The objectives of this study were to determine the diagnostic accuracy of preoperative, surgeon-performed ultrasound (US) in assessing tumoral chest wall invasion (T3) in non-small cell lung cancer (NSCLC) patients and to compare its accuracy vs preoperative computed tomography (CT).

Sunday, July 20, 2014

OP ED Number 2

Yes, this is my second OP ED, aside from a recipe post.  I have much to celebrate.  One:  My son will be back in the USA from a missionary trip to Guatemala this afternoon (Yes he is a legal United States Resident).  They helped rebuild some community facilities in a small village there.  I will post the GO-PRO videos on my FB page. The image to the left is a picture of a volcanic lake in Guatemala called Atilan.  I went on a mission with a church 7 years ago to provide medical support there.  I taught a nurse and a physician to do limited and focused sonograms on the village people to triage them and get them to a hospital.  The living conditions are rather horrid by western standards.  The people there are chipper though, always with a grin, and a nice word.  They make do with little to nothing.  I brought an old GE ultrasound machine and taught these wonderful people how to use it for things like ectopic pregnancies, and acute abdominal pains, trauma etc.  It is not like these people here have a med-evac system.  To get to a proper hospital can take hours in a car or truck.  The trip was a great experience for me, and my son is now queuing up at the airport to come home.  This is his third journey.  My wife went on the first.  You can say we are all Guatemalan pros.  Trevor, My Son, I am PROUD.

Second:  I am working at a small hospital, and giving lectures on the side.  I cannot wait to visit the town of Kerrville, TX to present some education to the wonderful sonographers there at a specific large hospital!

 Of note: I have a student where I work.  She is doing very well with the limited education she got at a for profit fly-by-night ultrasound school in Houston.  On Wednesday of last week we had an educational meeting where I outlined what to do when she encounters a ruptured ectopic pregnancy.  Lord Have Mercy!  She was on call that very night and had a bleeder.  The abdominal cavity was filled with blood.  They did a great job and took her by air ambulance to a large hospital, and saved her life.  My sonographer student NAILED the diagnosis.  We are having a party for Logan on Monday morning.  A success like this defines both a teachers role, and a willingness of a student to learn, and act.  Logan, I am PROUD!

Sincerely, TJW

Visual Sound

Here is a great link to a visual way of understanding sound.  Sound is, in fact, a mechanical longitudinal wave of energy.
We sonographers take for granted that the transducer we place upon the patient is doing "something", but many of us do not understand the physical principles involved.  I will post a link to give us all a visual reference to what happens when a sound is created.  Enjoy.
Thanks Fluke Corp, and Nag on the Lake, and Gerard.



Saturday, July 5, 2014

Fatty Liver

Contrary to most people perceptions, liver failure is due to eating the wrong stuff, and not working out.  Walking, running, and getting out to have fun  America is a sloth society. Our ancestors would wake at 4 AM, and milk the cows, and tend to strenuous activities.  They worked off the calories we people take for granted.  Many Americans get up in the morning and eat like our ancestors did, get in a car, and go to work to stare at a computer.  They take a break to smoke out side the 15 foot radius imposed by liberal nicotine Nazis.  They drink coffee from machines with jail-house coffee blends.  They buy a coke from the machine.  (1.25 US).

Many Americans eat at work.  They call out for FAST FOOD.  I am guilty.  I work my buns off, and when I am hungry I will eat any thing.  But I work.
Our kids are not mowing yards anymore.  The Illegals are doing that.  Our kids are sloths eating Capn crunch, and other crap.

We are seeing many kids with high blood pressure, and obesity because of a poor diet.  Liver failure is a horrid end to our children's lives.  Please.  Feed our kids something other than KFC. Our kids Are obese and very lazy.  This was a Public Service Announcement paid for by my 44 year old parrot.  Be well, and love your relatives.http://www.cdc.gov/healthyyouth/obesity/facts.htm

  • Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years.1, 2
  • The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to nearly 21% over the same period.1, 2
  • In 2012, more than one third of children and adolescents were overweight or obese.1

Thanks CDC