Tuesday, July 23, 2013

Retrospective Part Five

I apologize.  It has been many months since I sat down in my mancave to compose the fifth in a series of retrospectives on the history of diagnostic ultrasound, and my part in it.  Please read the first four by scrolling down through my archives to get a feel for what I am writing about.  My last post was about echocardiography.  To the left you will see one of the first real time ultrasound machines I used as a sonographer.  Echocardiography was pioneered  Dr. Harvey Feigenbaum.  His book is widely thought of as the bible of echocardiography.  ISBN 0-8121-1692-7  That is the ISBN number.  Google it.  The machine you see to the left was crafted partially by Donald Baker, who is the husband of Joan Baker.  Joan is (As far as I can tell without doing google search) is the first ARDMS registered sonographer.  I did a quick search.  Google has no idea, neither does Ask.com.  Let's leave it to popular legend. But I know Joan.  She currently travels the world and teaches Sonographers how to scan properly without damaging muscles and tendons.  I have never met Donald.  I would love to shake his hand.

 I worked in a hospital in north Texas in the 1970's.  I took care of people with my new ATL machine until the salesperson of the machine greeted me.  His name was Clark Ulmet.  I hope he does not send the Nazgul down on me and my family for using his name, because he got me really started in the ultrasound business.  His daughter continues the tradition selling healthcare products. Clark got me in touch with a radiologist in Tyler TX.  He and his partner asked me to help out starting a mobile business.The owner actually flew me home in his private plane.  He and his partner got me interested enough to eventually gain my own private pilot's license.  At that time I had a full head of hair. When you have a head of hair, anything is possible. I said let's do it.

I arrived in my toyota pickup truck with a 70-ish boat on the hook and got a cheap apartment on the south side of Tyler.  I reported to a cheap ass office that smelled of smoke and other substances like cheese, and vanilla, and I would grab that big machine and  I would bully it up on a wheel chair lift on a Dodge Ram Van and wrestle it into place with cords, ropes, whatever was around.  I would then take off to visit three or four hospitals and see patients. We kicked the crap out of East Texas.  James and I delivered damn good health care to so many people.  We both arrived home and ready for a shower. All sonograms recorded on a video tape.  Echos were a combination of video and some pink thermal paper.  We used a microphone to tell the interpreter what we were looking at.  Most interpreters had no idea what they were looking at.  The tradition stands to this day.

Needless to say I learned how to fish. Crappie, Bass, Catfish.  I pursued my other love:  Music.  I played 5 days a week in a band called the "Country Boogie Band", and made some good money playing keys.  I met my current (and only) wife there at one of the hospitals I took care of.  In the next installment I will tell about my journey to the University of Alabama.  And a meeting with a most wonderful doctor named Navin Nanda MD.  He taught me everything about color flow Doppler, Pulse wave, CW and a KFC bucket load of other things.  And Yes, I am a Texan.  Be well.  TJW

Sunday, July 21, 2013

Vascular Testing, DVT, And the Lot

One of the many issues sonographers have to deal with is the source of an embolism.  Currently, when a patient has a CVA (Stroke) or RIND (resolving intermittent neurologic defect), and echocardiogram and a carotid Doppler are ordered.  This post does not deal with these issues, rather I am posting something far more reaching.  Guidelines for ordering vascular testing.  Often times we are called up at 3am for a DVT study.  Most  people do not understand that DVT does not cause a stroke.  It may cause a pulmonary embolism.  Patients who suffer from atrial fibrillation have a high incidence of stroke.  This is why they are commonly prescribed medications that reduce the incidence of clot formation in the left atrium of the heart.  I have no issue with this therapy.  I think it is common sense.  As an echocardiographer, I must always be vigilant for masses in the heart.  But here is something I came across at Sonoworld.  Blessings to you folk's.

Applicable to patients with venous disease and severe chronic kidney disease

A new report issued today by the American College of Cardiology (ACC) and developed in collaboration with 10 other leading professional societies provides detailed criteria to help clinicians optimize the appropriate use of certain noninvasive vascular tests when caring for patients with known or suspected disorders of the venous (veins) system. Also included are first-time recommendations for when and how to use these tests to plan for or evaluate dialysis access placement.
"Vascular lab testing is central to the care of patients with most peripheral vascular disorders, but appropriate use criteria for these [technologies] have lagged behind those for cardiac testing," said Heather Gornik, MD, FACC, cardiologist and vascular medicine specialist at the Cleveland Clinic and chair of the writing committee. "With this report, we now have multidisciplinary criteria upon which we can start maximizing the quality and appropriateness of what we do in the vascular lab every day."
Vascular testing is often used to help evaluate possible venous thromboembolism, which is the third most common cardiovascular disease, after coronary disease and stroke, and includes deep vein thrombosis (DVT) as well as pulmonary embolism (PE). These conditions can be fatal and result in hospitalizations and long-term complications. Therefore, identifying the best methods for detecting clots in the veins early on can be lifesaving, Dr. Gornik said. "But we must know that we are ordering the right test for the right reasons," she added.

Here is the link  Thanks Sonoworld
This post has been crosslinked to Echocardiography world

Friday, July 19, 2013

Off Topic, But Important

Here is something I need to post.  I put it on FB, but I must post it here.  Our family is proud that our son is going on an epic journey to another country.

Just a note to friends: My son is in the air at this moment traveling to Guatemala to do some hard work for our church. My wife and I are not on the plane. This is his first real journey to see what the world is like without McDonalds, and Taco Bell, and the air conditioning we Americans have come to accept as something we are used to. He did not take his X-BOX. Our family is all about health care. All three of us have been to Guatemala on mission trips. My trip was 7 years ago to deliver an ultrasound machine and provide education to the doctor and nurse who take care of thirteen tribes of Mayan Indians who live near lake Atitlan. My wife traveled there 3 years ago to administer vaccinations as a nurse. Today mark's a family tradition. My son, Trevor will put muscle and intelligence to work to assist people to get better living conditions. I am proud of my entire family. Pray for his success, and safe return.

Be safe all and drink water.  Hot summer.

Blessings.  TJW

Thursday, July 18, 2013

Blogger Is Hot Today Editorial and Apology

My post below has some obvious errors in formatting and other stuff.  I have tried three edits.  They have not worked.  I want you all to read the articles I have posted below on ultrasound brain stimulation and ablation.  I apologize for the errors, I think the excessive heat may have something to do with it, but I will take all the blame.  I try to speak about ultrasound only here, but we are having a hot summer, which may influence the internet.  I am not sure.  Perhaps the heat of a nation in political strife?

Ultrasound Brain Stimulation? Can We Really Do It?

A year ago I came across a lecture on TED by a Jewish neurosurgeon Yoav Medan that discussed a single case of taking out a disease in a few seconds using MRI guided high intensity focused ultrasound (HIFU).  I published this article before, but it seems we have a call to be optimistic about the results of further studies along these lines.  I present the original TED video, along with some other interesting articles.  Thanks you folk's who lead a wonderful cadre of untiring researchers looking for answers.

First off the TED Video:  http://www.ted.com/speakers/yoav_medan.html

The URL did not show up on the Blog.  Please go to TED.com and use the search box to find Yoav Medan.  You will find it.  Sorry for the glitch.  Thanks TED for your wonderful lectures.

PLEASE watch the whole thing.  You will be amazed.

Second, I would like to discuss an issue that affects millions of people around the world:  Depression.  There seems to be preliminary data that suggests stimulation of brain tissue with ultrasound helps the brain to re-organize the neurons into harmonious units, thus allowing for a elevation in the mood of patients who suffer from depression.  This article is astounding, and will blow the sock off of anyone who is not a particle physicist.  But I will post it anyway.   Perhaps the author is on to something.  Blessings.  TJW

Imagine that you've just come home from a hard day at work. 
Maybe you had a run-in with your boss or were stuck in a meeting than ran an extra hour. Perhaps a project deadline forced you to skip lunch. 

Instead of working out or having a drink to relieve your stress, you plop down on the couch and put on an odd-looking hat. You open an app on your smartphone and choose a setting called “mood.” High-frequency sound waves begin to pulse from the hat into your brain. You start to feel more relaxed.
Thanks SonoWorld and Wilcox news and www.ted.com

Sunday, July 14, 2013

A sonographer is a human.  We are not computers.  We are the people that greet you and treat you with respect.  We tell you we are going to probe your body in intimate ways.  We are some of the most intimate health care providers you will encounter in the medical world.  We look into your chest, into your arteries, and into the womb.  We are people who know you from your ass-hole to you appetite.  We love our patients.  We know when the bulge in the abdominal wall is a hernia, or a sign of cirrhosis of the liver.  We are frequently the first people to find that your foetus has a heart beat, or not living.  We are not nurses, or doctors.  We are the people that try to figure out what is wrong with your tummy at 3AM in the morning.  We are frequently questioned by doctors as to what the diagnosis is.  Many of us offer non-legal opinions.  Most of our opinions make or break a medical decision.  We sonographers are careful, and thoughtful people.  We make our decisions based upon extensive medical histories, lab results, and physical findings.  Sonographers are some of the most valuable people on the planet. Sonographers are often very well educated.  Most sonographers are certified by an agency in the USA. Many sonographers suffer constant callbacks, and scrutiny by scruffy radiologists, cardiologists, and other medical doctors who think they know how to interpret ultrasound images. Many sonographers must interpret the images for the physician because the physician lacks knowledge.  All patients ask the sonographer if there is something wrong.  We are trained to be poker-faced.  Some of us do not know how to play poker well.  We are all human.  Next time you have a sonogram, echocardiogram, carotid ultrasound, venous ultrasound remember that we sonographers are humans also.  We care about you.

Written with Respect.


Ultrasound Gel And It's Proper Use

I have two stories here for your reading pleasure.  One about the safe use of ultrasound gel, and another about using guacamole as an imaging medium in scanning non-human primates.  This first story deals with a pet peeve of mine:  tossing out old ultrasound gel bottles.  I think most sonographers are aware that ultrasound gel can harbour bad pathogens, and the gel warmer is a great incubator.  Most but not all sonographers regularly toss out used gel bottles on a monthly basis.  One further note before I paste the link regards the use of bottled ultrasound gel as an endovaginal lubricant.  I find that practice horrendous.  Why introduce pathogens into a females vaginal canal from a warm bottle of gooey gel that has been in the warmer for a few months?  Always use sterile KY jelly packets as the lubricant when performing these procedures.  Here is the link all sonographers should read regarding this subject.

CHICAGO (November 12, 2012) – In the December issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, guidelines have been proposed by epidemiologists from Beaumont Health System to reduce the risk of infection from contaminated gels. The recommendations are based on the authors’ own experiences with an outbreak traced to contaminated ultrasound transmission gel.
In December 2011, researchers uncovered an unusual cluster of Pseudomonas aeruginosa in a cardiovascular surgery intensive care unit during routine infection control surveillance. The outbreak was found to have stemmed from bottles of ultrasound transmission gel that were contaminated during the manufacturing process and that were being used for intraoperative transesophageal echocardiography.  This information ultimately led to a national recall of the product.

Thanks Sonoworld

Next I present a novel use of guacamole as an imaging medium in scanning non-human primates as seen in the picture above.  It make sense that the female can feast on the treat while allowing the sonographer to image the unborn child.  Blessings!

Getting an orangutan to agree to an ultrasound is as hard as it sounds, but Fresno Chaffee Zoo keepers found the solution - guacamole paste instead of ultrasound gel.
In Atlanta, zookeepers armed with fruit snacks have trained gorillas to place their arms into blood pressure cuffs.
Zookeepers are relying increasingly on behavioral management to provide better health care for animals in captivity.
Advancements in training have allowed animals to help themselves, said Grey Stafford, director of conservation at Wildlife World in Phoenix and an animal trainer for 20 years.

Thanks Times-Tribune

Friday, July 5, 2013

HOCM I Found One This Morning

I found a HOCM.  It pleased me because the cardiologist did not hear a murmur.  The lady was very offensive.  She was a little old tweety bird with leg artery disease.  She hated me for invading her birds breast thorax.  She never complained about the procedure, but she bitched about the time it took to perform an echocardiogram.  The cardiologist wants to invite her in for a sniff test.  Amyl Nitrate.  Let's see if she will come back in for the test.  Comments will be welcome.  I have not done a sniff test in years. Blessings all.