Deep Venonous Thrombosis, The Trauma To One Family

I have not posted in a few months because of a family issue.  My wife came down earlier this year with a pain in her left calf muscle.  She has some arthritic changes in legs, and I dismissed it.  We were having coffee at 7 AM, and both hustling off to work.  We are both health care providers.  She is a nurse, and I am a sonographer.  I never thought I would receive a call from St. Luke's ED a few hours later.  My wife was in the ED suffering from shortness of breath, and tachycardia.  She had suffered a pulmonary embolism.

Let's step back a few feet and review what causes pulmonary embolisms.

Most are caused by clots that develop in the lower extremities (legs).
So what causes a clot to develop in your leg?  Well, many things can cause a DVT including obesity, inactivity, clotting disorders,certain medications, travel in planes, varicose veins.....this list goes on.
On occasion, the clot(s) may travel up the leg to the pulmonary artery to become lodged there in the artery that feeds the lungs.   BAD NEWS!  If the blood cannot get to the lungs to be cleansed, you may die of lack of oxygen.  I would agree a most horrible death.  The heart may protest also sending out signals to the body that it is starving for o2.  My wife had palpitations that she recognized as life threatening, and presented to the ED pronto.

My wife had no risk factors.  She is a thin, and very active lady.  The doctors were shocked.  She was enrolled into MD Anderson's clinic near where we live and accepted into a study group.  She was atypical.  Her risk factors were nil.

Treatment

My wife started on a regime of anticoagulants starting when she presented, and her pulmonary blood clots were taken care of.  The regime included a horrible set of drugs named warfarin, and lovinox. The warfarin is essentially rat poison.  I tried to google "warfarin" but I got too many POP ups to link it to this post.  Google it yourself.  LOL  I hate ADS.

The lovinox is essentially a nasty and expensive drug that we had her take in the first few weeks. It has replaced heparin as the drug of choice for acute PE and DVT.  Lovinox cost us $250 a week, and was NOT covered by insurance.  We are still recovering from the monetary costs.

What are the long term effects of DVT and PE?

I could write a books. 

Post phlebotic Syndrome is one.  This is where the leg is painful, swollen, and an infection may take over, causing ulcers, and other nasty issues.  Diabetes, and high blood pressure aggravate this disease.

In short, DVT and PE are not a disease state to be taken lightly.

My wife is doing well at the moment, And I will comment more on this subject in future posts.

Be Well,  TJW

WINDOWS 10

Uploaded W-10 to a lap top as an experiment.  It is always gutsy to upload a new OS to a computer.  It is SLOW.  Like a Blue Whale!.  It takes more time to load than my oatmeal can start burping in the microwave!.  It has moments of flatus.  Lemme clarify:  It pauses, "honks", then resumes a bowel movement somewhere on a silicon chip, then resumes, like nothing ever happened".  Problem is, I am 15 minutes without a cursor, and cursing.  It Sucks.  Peace, TJW

DVT, THE OUTCOME

If I were a fife player, I would pipe a merry tune.  My wife will be back at work, soon. (help me Ian Anderson).  My wife is much better.  My post is about my wife's battle with health care, and insurance, and long waits to see a Doctor.  Our health care insurance does not cover acute life saving meds for DVT.  I will not mention the the drug.  We are making way, though.  She will wreak havoc in the clinic she works at as a nurse on Monday.  My Wife, has been a pent up bull for many weeks.  Having DVT, and a PE is nothing short of scary to me as her husband, but scary as shit.  Discussion:  a DVT is a clot in a major vein in the body.  When the clot breaks off, it flows through the right atrium of the heart to the right ventricle, which pushes it up into the main pulmonary arteries (left or right).  It can then clog a blood vessel that allows for oxygen transfer in the lungs.  This may cause shortness of breath.  Which my wife endured.  She promptly presented herself to the ED and was treated.  She was hospitalized for an ordinate amount of time.  

Alas, many of the tests, and procedures are not covered by our measly insurance.  But our health care system worked for us.  My Wife still lives, and works.  The key is "works".  Many catastrophic health care situations leave a spouse unable to work.  Consider a heart attack, when a spouse cannot work.  Consider me, and my family lucky.  My wife is already passing out gifts to the needy people in our community today.  She love's to help people.

 

 

DVT, A Personal Diary

My wife came into the kitchen last Tuesday saying her calf was hurting.  I told her that he miniscule varicosities can be painful.  We both went to work.  I get a call at my place of business, which is a small hospital in south Texas.  I see that call is from my wife.  I was sitting at the front desk of the X-Ray department.  (Yes we call it X-Ray in south Texas), other places call it Radiology....and since we have CISCO phones, I saw it was my wife calling.  Cell phones do not work in our hospital.  Probably for a reason.  Too many people would be playing candy crush or angry birds.

She was at a large hospital in Houston in the ED.  I almost had a technicolor bowel movement.  She told me she had a pulmonary embolism.  Her O2 SATS were 82% on admission.  The did a leg U/S, and a chest CT.  Great. 

Problem was the source of embolism was her peroneal vein in her left leg.  Atypical!

Darn, Heck, and H-E-double L!

I clocked out, and went to lend a feeble hand in her admission process:  Wheeling her up to the fourth floor into a private room. (Nice)  And we got her some food.  My wife is a nurse, and is not a typical DVT patient.  She is lithe, active, and determined to have her way.  She gave me a list of stuff to bring from the house.  The list included pink slippers, a favorite pillow, toothbrush, comb etc.  I went home to gather things up and grabbed our son and gave him the news.

"Mom had SOB, and palpitations, and pain in her calf.  She has a blood clot in both of her pulmonary arteries" 

"What" said my son?

I explained it to him, and he shed tears.  I told him it would me OK.

We sprung her from the hospital, and she immediately started going through the discharge bills.   She found she was charged for two units of whole blood which she did not get in the IV.  Her OP prescriptions hit us like boulders: Coumadian, and a shot form of low-moleculoer weight form of heparin.  The shots would cost $275 a week.  Insurance did not cover it.

My wife is home now, and the doctor bills are mounting.  She has a pulmonologist, a blood doctor (Haematologist), PCC, and an endocrinologist. 

My wife is a nurse, and she is pissed off.

Discussion:  Most DVT arise from the above knee veins.  Her DVT is strange.  the peroneal veins are typically small veins that run on the inside of the calf, but they are deep veins anyway because they are accompanied by an artery.  Hat's off to the Sonographer that grabbed this one.  Sadly, many poorly trained sonographers do not scan the PTV's, or the peroneals.

She is doing well.

Sorry for the lapse in posts. it has been an interesting summer.

TJW

Ultrasound Sonography, version Two, Sonographers Blog.

I have been away dealing with family issues. When you have a wife and a family, all stuff goes wrong at some point.  I have been away from my Blog for a bit dealing with wills, and my older Mother and Father.  We are getting ready for them to be dead.  Such is life.  I need new glasses.  I need to see with my profession.  I am a Sonographer.  I depend upon my eyes to help patients.  I will schedule an eye examination this week. It pretty much sucks to get old.  Thank You all for reading my BLOG.  I love you!  BTW, the web site SONOWORLD is no longer free.  You must pay them a fee to read anything.  LOL.  I will not pay them a fee.

I understand that ultrasound microscopes have value.  Here is a link

http://search.sidecubes.com/?category=Images&p=1&st=nt&ic=1&q=ultrasound+of+cancer

Blessings

TJW

BONES

Bone fractures occur.  I hate to say it, I am getting old, and I had a rib fracture.  It hurts to this day.  I pray for the wonderful people who fall down and injure themselves every night and day, and end up in the ED for medical care.  They are in horrid pain, I know.  I have had a fractured humerus, toe and rib.  Pain pills are not a long term answer..  I have long known a fractured rib hurts like Satan's breath.  Perhaps we can help the older people with a Sonogram of the bone.  X-Rays by Roentgen are great, but an ultrasound can be efficient.  Here is the article  TYVM  SonoWorld, andd SCIENCE 20


A study of portable ultrasound in detecting the presence of minor fractures in patients showed that 85% of patients with a fracture confirmed by X-ray had injuries detected through ultrasonography.

You'd still want a radiographer to rule out fractures but emergency clinicians could rule in fractures using ultrasound images, they conclude.

Ultrasound is a high pitched sound wave generated at a frequency of more than 20,000Hz in air, though the frequency changes depending on the density of the objects through which it passes.

Read more: http://www.science20.com/news_articles/sound_waves_instead_of_xrays_for_diagnosing_minor_fractures-155552#ixzz3aJSngk4l

THANKS Science20

Been Gone For a Few Days.

Sorry, I have a family, and I have issues.  I think everyone knows what it is like to prepare for deaths.  My Mom and Dad are in the 80's.  We have been going around with the bottom feeders (attorneys).  Enough.

Upper extremity U/S is great at ruling out CLOTS!

Shoot I have known this for years, and so have many of the great doctors I work with are great.  Here is an article from www.sonoworld.com to put this issue at rest.  Thanks Sonoworld!


Single whole-arm ultrasound can rule out upper-extremity deep vein thrombosis with a lower rate of repeat screening than a multi-step strategy using clinical scoring and D-dimer testing, researchers reported.
Ultrasonography has largely replaced venography for the diagnosis of upper-extremity deep vein thrombosis (UE-DVT), despite the absence of diagnostic management studies showing the practice to be useful for determining which patients need anticoagulation therapy, researcher Michelangelo Sartori, MD, PhD, of S. Orsola-Malpighi University Hospital, Bologna, Italy, and colleagues wrote online May 11 in JAMA Internal Medicine.

THANKS SONOWORLD, and JAMA

GO-PRO FOR THE FAMILY

My wife bought a basic go-pro for the family.  We are debating how to use it.  My thoughts are in the washing machine for a real view of how clothing is washed.  It is water proof.  Be safe  TJW

Get a go pro for the family, at least to document any car wreck you have for the insurance adjusters.  Russians do.  :)

NURSES ARE GODS

I am usually a very scientific, dry humor blogger.  I never show my humor in my posts, but being married to a nurse I will break my Draconian rules at least once.  As a sonographer, I deal with many people who are in pain, ill, or just looking for some opiates.  I have had my share of accidents on the examination table.  Sonographers deal with the ill patient like nurses, but on a limited basis.  We do not respond to the call bells, or deal with 12 hours of "I need my PAIN SHOT".

Sonographers are in awe of the God we call a Nurse.  Here is a post I hope you all share.

Do you remember what weekends are? Are you so immune to undesirable body fluids that you no longer have a gag reflex to suppress? Can you hold in a pee for hours, if your hectic job requires it? If you answered yes to all three questions – you’re probably a nurse.
Now, everyone thinks they know what a nurse is: the romanticised versions on Grey’s Anatomy probably help form the disastrously erroneous illusion they’re all sex-mad bimbos. Let’s be straight, though – if there was one thing the nurses in TV and movies wouldn’t be interested in (if they portrayed the profession realistically), it’d be sex.

Thanks to Nina Cresswell, and www.whatculture.com

 http://whatculture.com/offbeat/13-problems-only-nurses-will-understand.php

Sorry To Be Out

Out Of The Office

I am sorry, I have a family.  I will begin posts again after a family issue is resolved.  Many of you have kids and know what happens when we have issues with kids.  We get distracted.  For days, weeks, months.  I am beginning to come back to the blog to take care of the insatiable appetite of my buddies on this topic of sonography.  The topics are many.  I have much work to do.  I will not make posts at work because it is not allowed. Employers frown upon blogs.  So Be It.

I have a few topics to post, as a Sonographer.

The lion is a funny, but a real thing that a taxidermy person made poorly.  I l love it!

I cannot find the link to credit the person who took this picture. 



Bats.

They send out ultrasonic pulses where prey is in space. This is basically what bats do.  They use echolocation for the food with sound.  The pulses are ultrasound.  They tend to find a meal with ultrasonic waves of energy. Sound waves. Like we use our car horns to tell another person to move at a stop sign.  They have misshapen ears, and crazy noses, and they are for echo locations.  The noses and ears are for the radar of the prey they feed on.  Insects are primary, though many feed on fruit, and some on cows for blood.

” That’s how the science podcast Invisibility recently described Daniel Kish, a blind man who taught himself how to navigate by echolocation. But their description slightly misses the mark. While both humans and bats can paint visual landscapes from echoes, the pointy-eared flyers possess a stark advantage: ultrasonic sound."  

Interesting:    Many humans who are blind use clicking noise they generate with the tongue to find a way around.  Bats do it.  Humans should be able to adapt.  And they have.  This is interesting article.

Here is the link  TY
 http://www.popsci.

Blessings  TJW

Sonographers getting Old

I have a funny.  I have met a few people that said "what is an old ultrasound machine".  Here you have an ancient Hewwlett-Packard cardiac machine which saved many lives.  Hewlett Packard was the best echocardiography machine at the time. I wonder how many echocardiographers remember this machine?  The diagnostics on this machine allowed many cardiologists to take care of patients with heart issues.  I used this wonderful machine for many years.  I also visited the place where these machines were manufactured.  I gave a lecture there.  Massachusetts  Nice place, great food.  HP has been consumed by other companies.  Sad.  TJW

Ultrasound Probes

Happy New Year all.  Here is a tip for all Sonographers.  Keep your probes clean, and do not drop them.  The ultrasound probe (transducer) is the most important element on your machine. Sonographers treat the probe like a sacred instrument the doctors do not understand.  The doctors
 that order echos, and OB examinations have no idea what we do to give them vital information for the proper care of a  patient.  Final note before the link?
Keep the probe clean.

The life expectancy of today's sophisticated ultrasound probes is literally "in the hands" of the sonographers and echocardiographers who use them every day in the course of providing patient care. Given that upwards of 70 percent of all ultrasound service calls are probe related, it pays to consider ways preventable probe damage can be reduced in order to minimize patient risks.

Here is the link.  Thank You Sonoworld

 http://www.dotmed.com/news/story/24980

Small Hospitals Are Dyying Under Obama-Care

Yes, that is a praying mantis.  Ugly and hateful.  To be proper, here is the WIKI definition of the mantis:

Mantodea (or mantises, mantes) is an order of insects that contains over 2,400 species and about 430 genera^[1] in 15 families worldwide in temperate and tropical habitats. Most of the species are in the family Mantidae.

I post this because I have had a bad year.  Many of you have also had a bad year.  This post is long coming and spiteful towards people who believe in proper and caring health care.  I hope people realize they have a voice in health care.  Many medical institutions who profit from medical imaging are fat guppies.  Hospitals are seeing profits soar because of the over use of CT scans and MRI's.  Most small hospitals are in self defense mode.  The bulk of the profits are from medical imaging.  The current president wants to remove the the genitals of rural hospitals.  Our country hospitals are dying.  Many doctors and nurses and sonographers are losing jobs because of big hospitals metastasizing into small communities to make a profit.  We love our small communities.  We love our patients that come in to small hospitals to get a shot, or a breathing treatment, or just a hug.

Our hospital system is a great place for acute and chronic disease.  People think small hospitals are nursing homes.  I hate this.  I reminds me of a revolting film starring Chuck Heston.  Our small hospitals are not a parking place for re-cycle machines.  They are a place of dignity.  The reference to the mantis is one of a species of insects that recycles it's own.  Very nasty, and totally-false for humans.

Let's support the hospitals in the small communities.  A small hospital is very much capable of providing care that is effective, efficient, and with human caring.  Please support your small hospital.  They are a place of dignity, respect, and humans who LOVE others.  Happy New Year.

Gizz

Clot Buster Machine Is Coming!

I have blogged about the use of ultrasound and medications before.  I am happy to report some new tech is in the testing phase.  You saw it first here on SB.  We will use a combination of clot busting medications, and ultrasound to break up clots in the brain before a stroke can disable a person.  We all know that we hate to see a loved one go comatose.  Perhaps this will be a new tool to prevent the long term effects of stroke to manifest.  I am hopeful.


They say that with a stroke, “time lost is brain lost” – so when a stroke happens, each second counts to stave off further brain damage. Seattle-area startup Cerevast Therapeutics is developing a device that emits ultrasound waves meant to quickly dislodge stroke-causing blood clots in the brain.
And company just raised $10 million, according to a regulatory filing.
The company’s head-worn device, called the ClotBust ER, is made up of a number of ultrasound transducers that are placed in regions where the majority of vessel occlusions in the brain are known to occur, Cerevast says.

Credit:  Med city news    http://medcitynews.com/2014/12/using-ultrasound-treat-stroke-cerevast-therapeutics-raises-10m/