Carotids 10/17/2011

Surprise, Surprise I am going to attach some pictures of a carotid again.  This was a case that I worked on a week or two ago.  I was confused by the waveforms that were showing up in her CCA.  I will probably use this as a case study at some point, once I figure out what is going on. 

This was an 80 yr old patient with an altered mental status.  She did have some plaque at the bifurcation area, but her CCA appeared to almost have a tardus parvus waveform.  I took the pictures on the right side.

Unfortunately, the doctor that reads these cases has a different way of doing it so I have not been able to get the report yet.  I do know that tardus parvus waveforms have to do with the proximal stenosis. 
We scanned through the subclavian and saw plaque, but there was no stenosis.  At least not that we saw.  Maybe we needed to go further.

Just as a side note, I was pretty happy with the pictures that I took.  She was somewhat difficult to scan, but I was able to obtain all the pictures I need.  I feel that if we look back to my beginning posts we should see a big difference.  Next time maybe I will show a comparison of then and now.  

Tuesday 10/11/2011

Well, obviously it has been way too long since I have accessed this blog.  It took me awhile to even remember how to log in.  I will definitely get better.  I have some new images to post to show I have improved. 

I feel way more confident at clinicals scanning carotids and legs than I probably did the last time I post anything on this page.  I still struggle with abdomens and kidneys, which makes me feel a bit pathetic.  I suppose it shouldn't because I know that people at other locations have seen a whole lot more of them than I do.  I have improved though and am able to complete one.  I just need to work on my speed.  I will get there. 

I am very glad that I was able to comp out of my carotids in lab and I will post some of those pictures when I get a chance to show that I am capable of doing them.  I am going to sign up so that I am also able to comp out of my legs.  I fortunately get quite a bit of practice on these at my location. 

I do feel horribly lost in case studies when other students are showing their ob studies.  I have seen very few of these.  I definitely never see any of the babies that have real issues. 

I will start doing this blog!

10/06/2011 Thursday

One year ago today the world lost one of my favorite people.  I woke up for school only to check my email and find that my aunt had sent out a very nice reminder of my mom and how much everyone misses her.  Included in the email was one lone picture of my mom's hand that was wearing the wedding ring that had been worn by my grandma for so many years.  Since my grandma had passed away just 5 short days earlier my aunts had given this ring to my mom.  My mom being the funny lady that she was wore the ring with so much pride and flashed it to everyone that entered her room showing of her beautiful diamonds and bragging about how great they looked on her hand.  She was always a lady that knew not to take things too seriously and that there is always fun to be had.  I miss her so incredibly much with every day that passes.  She meant the world to me and I can't believe that she is no longer here. 

My sister's always joke that I cannot remember the day that she truly passed away, but in my defense I was out here in AZ so technically it was on the 5th.  I remember very clearly.  It was a day here of horrible weather.  We had hail and rain multiple times that day.  I remember because on more than one occasion I made the joke that AZ was angry my mom was not here where she belonged.  Later that night around 9pm while I was at work my younger sister called me to tell me she was going to hold the phone by my mom's ear so that I could tell her bye and that I loved her because they didn't think she had much more time.  That was one of the hardest things for me because I do not tell me feelings willingly.  Normally someone has to say them to me first, but I pulled it together for her.  Then sometime shortly after midnight my younger sister called again to tell me that she had passed.  A part of me is still very angry at myself for not staying in MN.  I do know that my mom really wanted me to return to school, it was very important to her that I finish. 

Shortly after the phone call all the storms had stopped and it was completely calm and peaceful outside, I guess because my mom was also at peace.  I am not the least bit religious myself, but know that my mom was spiritual and would have tried to comfort me in this same manner.  She truly was an amazing women and I am thankful for the time I did have with her.  I miss her every day, but together her and my grandma drive me to succeed at everything.  So, in order to not let them down I really need to buckle down and study.  I have to finish. 

Since I didn't feel those losses during my first sememster made things hard enough on me I went ahead and got pregnant.  Unfortunately, I have to go through all of this without my mom who would have been the greatest grandma ever. 

Let's just see how much I truly can endure before I shut down.  I am going to find a way to get myself through all this one way or another.  I just have to give myself a kick in the butt because I have never been an overly motivated person.  I am the person that does what I need to get by.  However, this program does require more work out of me.  So, now with all my added challenges I am getting that kick.



I know this is not the true purpose of this blog, but I am having trouble with my pictures right now so I am unable to post anything truly school related.  Plus I feel that my mom deserves some sort of memorial from me.  After all she is why I am in school again. 

Thank you very much to my mom and grandma for always pushing me to do better.  I promise that I will not let them down.
Anyway that is enough of my crazy ramblings.

Next posts will be school related.  I promise.   

Scanning

I have so much trouble remembering to do this blog.  I am not sure why. 

I am still working on the carotids, and have become much better.  For the most part I am able to finish one whole side on my own.  I still need to become a bit quicker, which is why I dont' really move onto the other side too often.  Normally the tech I am working with does not need to redo many of my images. 

I was also pretty glad this week, I was able to scan almost a whole venous leg on the patient.  I just didn't get to the posterior tibs.  I also had a bit of trouble with the long pictures of the profunda and the prox femoral vein.  It did make me feel a bit better because the tech that took over also had some trouble with those pictures.  Obviously they were able to get them, but it did take a bit more work and they explained to me that it was just because they were pretty small vessels and very close to arteries. 

I feel that I have also made a lot of improvement with the scanning of kidneys.  I still have some trouble picking out the pathology, or making pathology when there isn't any, but overall my pictures are looking much better.  I recently worked with a tech who had been on maternity leave for awhile and just came back and said she had noticed an improvement in my scanning.  That made me feel very good, because sometimes I feel like I am stuck and not making any headway. 

I will include a few more pictures of some carotids.  I need to save some more images to my drive so I can definitely add images of something other than a carotid next week.

Distal CCA

Left ECA

CCA mid

Carotid Scan

I am going to finally attach some images that I have scanned.  I did this exam a few weeks ago on a patient with a history of carotid stenosis.  At my location a normal carotid exam starts with the transverse images of black and white images of the proximal, mid, distal, bulb and bifurcation(b/w and color) of the CCA.  Next we move on the sagital images.  These consit of proximal, mid, distal CCA in black and white, color and with doppler.  Then the bulb in b/w and color, followed by the ECA in black and white, color and doppler.  Then the ICA prox, mid and distal in b/w, color and doppler.  Finally followed up with the vertebral and subclavian in b/w, color and doppler.  In our system there is a vascular calculation, where you input the different velocities and print the report to provide the doc with that information.  Overall, I do like doing this exam.  They can be a bit challenging still for me, but I am getting better with each one. 

This is an image of the proximal CCA.

\

03/20/2011

Well, it looks like I am a bit behind on my blogs.  I know I am not supposed to write them all at once, since we are able to see when I did them.  So, I will just write one now and maybe some more later. 

It is the last day of a nice much needed spring break.  It went too fast though, as does all time off.  Now back to work.  I know that I am also supposed to be posting pictures that I have done at the hospital, but still have not been shown how to get them.  I will make sure that I do that this week, and include them on my next blog. 

I am still working on the kidneys, carotids and legs at the hospital.  I would have to say that the carotids are probably my favorite exam at this time.  They tend to be the easier exams for me to complete and do.  I have become much better at elongating the vessel to get clearer pictures, and have also done better at distinguishing between the ICA and ECA.  Hearing the difference in the waveform has really helped. 

I am still struggling with the stinking kidneys.  Depending on the patient I still have a decent amount of trouble.  I always feel like I am pushing so hard and getting decent pictures and then someone will come in to help me and their pictures are like 100 times better than mine.  I know that this will all come in time, just would like it to come a bit faster for me. 

I also feel like I am a bit behind when I hear other students talk about what they are doing or have done.  This I know partly is because of the location I am at and due to some family emergencies with my clinical instructor, but I am working on it. 

I don't know what else to write right now, since I don't have a specific exam to discuss.  I promise that next week I will have pictures and an exam that I can discuss in detail and address the problems and what went well.  I need to remember to do this blog!

So long Spring Break!!

Lateral Resolution

Yea Physics!

Lateral resolution is the minimum separation of two interfaces aligned along a direction perpendicular to the beam.  It depends on the beam width.  Plainly, it is the ability to distinguish two objects side by side. 

There are a lot of variables that can affect lateral resolution: frequency, depth, focus, number of focal zones and cross beams.  This make is it very hard to measure consistently. 

Each sound beam that is sent out travels straight to the focus and then spreads out, making the beam wider.   Where the focus is, is where your image will be the best, as the beam gets wider all the sound beams begin to overlap causing the dot to be picked up most often.  This makes it appear longer, because it is spreading from one beam to the next at the wider portion.  This all makes sense in my drawing, but am unsure if I translated it right in this explanation.  I sure hope so. 

1st week of Feb

I am having a horrible time remembering to do this.  So, here goes.  This week was pretty good.  I got to spend a whole day with Janet, which is very helpful.  She is so good at explaining and showing me how to do things.  She also takes a long time letting you scan and helping you along the way.  I find this incredibly helpful and am very grateful that she is willing to spend so much time. 

I got a bit more comfortable with my carotids and legs thanks to all her help.  I was able to complete the whole left side of the carotid with the help of another very patient tech.  It just takes so much work getting the vessels as long as you can and making sure everything is lined up to get the best doppler as possible. 

I was doing pretty good on the venous legs as well, until Alissa and I went to the ICU to scan a patient that had severe pitting edema and we could not get anything.  I got the first 2 pictures and then would get stuck in the imprint left by the transducer.  At first Alissa thought that it was crazy that I was pushing so hard to close the veins, so she took over and found out that it really was just that hard.  It will be rough to scan those patients all on my own when the time comes.  Thankfully Alissa is also very helpful and always tries to give you plenty of time to scan. 

I really just need to work on my confidence.  I also need to push harder and figure out how to work around those stinkin' ribs. 

Thursday 01/27/2011

Well, I hate to say it but I did not feel like I accomplished much this week.  I had school for 2 days, and then all day Wed I just followed a sonographer, I didn't get to do any scanning because we were busy.  Then today I had to go to a 3 hour orientation meeting.  I learned about stopping the spread of infection and about the different aspects of the medical imaging department. 

I did however get to scan an abdomen today with a big part on my own. I was able to get the right kidney and the sonographer kept all my pictures.  I was pretty happy about that.  I was also able to get the gallbladder pretty clear.  Unfortunately, I was unable to get a good image of the stones within the gallbladder.  I still  need to work on pushing a lot harder, especially on larger people. 

Next week I really need to get more scanning time in. 

Jan 3-7th.

Well, I am not a hundred percent sure what I should write about.  This was the last week of full time clinicals.  We have to go back to school next week.  I am a bit scared about that. 

Let's see what did I see that was interesting this week at the hospital.  I got to see a scan of a man's scrotum that made for some neat images.  He had had surgery on the right and then more recently a lot of pain and swelling.  The scan showed a decent amount of fluid on the right.  The fluid was constantly moving around, which made the pictures look kind of neat. 

I have been able to scan a bit more mainly the carotids and kidneys.  I like how the carotid images turn out.  I have a lot of trouble getting the long images.  It is a bit rough to completely clear out the vessel to get the best b/w image you can.  I was working with a tech this week that let me start an exam while he finished up some stuff.  I finished pretty much all the images of the right kidney.  I was worried that they may not have been the best, but he kept all of them.  I was pretty happy about that.  The only thing he went back and did was take a better look at the pathology that I thought I had seen. 

I have learned that I do not push hard enough with the transducer.  Whenever someone is helping me scan they immediately stick the transducer down and get a much clearer image, and realize that I was not pushing that hard.  The only time I have discovered that I am pushing too hard is on the lower extremity venous studies.  Of course this is when you do not want to push too hard so that you are not pushing the vein too hard. 

I got to see my first pelvic exam of an actual pregnancy.  The only 2 before this week were most likely ectopic pregnancies.  This one was there was an actual fetus that could be visualized.  It was interesting and neat to see the measurements and what they mean as far as the pregnancy.

Well, that about sums up this week.  I need to start becoming more confident and faster at the exams that I am helping with.  I am starting to get pretty comfortable with the paras and thoras.  At least setting everything up. 

Goals

In order for me to be successful in this program I need to get myself back on track.  I have never been a poor student and it is freaking me out that I had so much trouble so far in school.  I am going to really have to buckle down and get myself together.  This means a lot more studying than I have ever done in my life.  It also means that I have to put school ahead of everything.  No more slacking off.  I have to get my whole life back on track.  I know that I had excuses to fall back on the first semester, but it is not what my grandma and mom would have wanted from me.  Both of them were very excited with my choice of majors, so now I must show them and me that I am able to do it.  I cannot let them or me down. 

My other main focus needs to be making sure that I am getting as much scanning time as I can.  Even if this just means that I just start the exam while I wait for the them to come over and take over.  I also need to work on the worksheets that Janet has so nicely put together for me.  Right now I should be focusing on scanning the renals.  I know the whole protocol, I just need to put it all together. 

I will start the new semester out right.  I will get myself re motivated to succeed, because I feel that ultrasound is a great career choice and something that I will very much enjoy.

Clinicals

Well, it was a pretty busy week back.  I have gotten more used to the flow of the hospital and have gotten a chance to watch a lot of exams.  I have also had a chance to to start some of the exams such as the carotid and renals.  I have gotten kind of comfortable with all the transverse images.  Now I need to focus more on clearing up the picture and getting the vessels as clear as I can.  I have had some trouble with the kidneys.  We have discovered that I am not pushing hard enough.  I need to start working on applying more pressure and realizing that if it is really too hard the patients will definitely let me know. 

Poor Janet has had a lot going on recently, but I was able to follow her around a whole day this week.  She is very helpful and great at explaining things.  She took me through a most of a carotid exam including the black/white, color and doppler images required for the protocol.  It is a bit rough remember all the buttons and stuff that you have to push in order to take the pictures.  Janet makes it seem so easy until she lets go of my hand and I lose the place she was. 

I am very glad that everyone at the hospital has been so helpful and patient.