Posted on July 27th, 2017 by wombwithaviewblog.com

Consulting Dr. Google About Your
Abnormal Fetal Ultrasound

 

Don’t do it, Moms-to-be! As much as you may be tempted, I have to caution you to not web-surf regarding your abnormal fetal ultrasound. Here’s why…

Because you surf the net for these details, you end up finding an entire spectrum of possibilities ranging from normal to severely abnormal fetal findings. And most of them may not apply to your circumstances at all. The result is usually the same. Your imagination runs away with you, and you start to worry that everything you’re reading applies to you and your baby. I always know a mom has been consulting Dr. Google when I get questions like “Is my baby’s bladder inside its body??” My response is usually the same…I reassure her with an “It sure is!” Then with a little smile, I advise “Quit looking up stuff on the internet!” Moms’ responses are usually the same, too. “I know, I know…I just can’t help myself!”

In this day and age of anything we want to know at our fingertips, it is nearly impossible to NOT research something that piques our curiosity. So, naturally, when you get your ultrasound results from your doctor, and he mentions you have a lot of amniotic fluid (polyhydramnios) or your baby has cysts on its brain (choroid plexus cysts), you freak out a little (or a lot). It’s completely understandable! But these findings may VERY WELL not be a reason to panic!

If Your Doc Wants to Refer You

Sometimes, we sonographers (even the experienced ones) detect things we just can’t explain. This doesn’t mean something detrimental to your baby; it just means we can’t fully explain it. We know this is disconcerting to an expectant parent(s). Usually, if something requires the attention of a high-risk specialist (aka a perinatologist or MFM or Maternal Fetal Medicine), your doctor will tell you when he discusses your ultrasound results. In such a particular case, he/she will usually express that something noted on the examination stands out as abnormal (or possibly a normal variant – something that’s a little different but considered normal), and he would like a second opinion.

In my experience, if your provider feels it is not grossly worrisome, he/she will say so. Your doctor will then refer you to MFM so they can do a more extensive Level 2 ultrasound. The perinatologist should discuss this ultrasound with you, provide an opinion on the issue, and the severity of the problem. MFM will also let you know if they feel there really is no problem.

If Your Report is Normal

If you are not referred to a perinatologist, then it’s very likely that nothing worrisome enough was seen on your ultrasound. Your doctor will also let you know that your ultrasound was negative or unremarkable. At times, we can’t see something well because of Baby’s position or other factors. Usually, it’s something like Baby’s heart or spine. In these cases, your doc may want to look again to ensure a normal appearance. There are many minor findings that we may note on a regular sonogram which may not be alarming to your doctor. Mostly, they just require a follow-up later to see if the issue is resolved. They mostly turn out to be insignificant, especially if no other abnormalities are seen with your baby. In other words…they are likely not a big deal!!!

So don’t make yourself worry! Don’t ask Dr. Google, ask your doctor instead. Make a list of all your questions, and he/she will let you know if other tests are needed. I know it’s tempting, but this is only the beginning of all the things that drive us crazy as moms! Save your sanity for when your kid is a driving teenager!

As always, thanks for reading!

Please feel free to email with any questions or comments at
wombviewerblog@gmail.com.

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Posted on April 29th, 2017 by wombwithaviewblog.com
Ultrasound results, twins

8-Week Twins!

Ultrasound Results – What’s the Big Deal?

Your ultrasound results must always come from your physician! But why can’t your sonographer just tell you if everything looks okay? It’s so irritating when she won’t talk, right?

The most frequent question a patient asks is if everything looks okay, healthy, or normal. Usually, to the patient’s dismay, this is something we just can’t discuss with you. Read on for details about why we have to be so doggone tight-lipped!

Ultrasound Results Have to Come from the Docs

My usual response when a patient asked this question is “Your doctor has to look at all of these images and he/she will discuss your ultrasound when you see him/her next.” Only your physician has the legal right to give you this information.

Yes, it is my job to know what I am seeing and to recognize it when something does not appear normal. However, sonographers are not physicians. We are trained to perform your ultrasound examination; we don’t manage the health of you and your baby. Your doctor studied for many years learning how to do just that. And only your doc or other healthcare provider can answer the multitude of questions you will positively have in the case of a suspected problem.

Our job is to share what we see with your doctor. Your doctor examines the information and concludes whether he or she agrees with our findings. The doc then shares his/her interpretation of the information with you along with what options he/she recommends next.

But, But…

Occasionally, I will have a persistent patient or spouse who will say, “Yeah, but you KNOW whether you see something wrong or not.” I’ll admit that I do, but I always defer to the physician’s interpretation. We just have to stick to our guns! I know it simply comes from a place of parental anxiety. We do understand.

For the nervous patient, waiting for ultrasound results can feel like a lifetime. I do empathize. A previous pregnancy loss or abnormal ultrasound is enough to scare serious fear into the hearts of anyone. I want expectant moms to understand that if your sonographer says something inappropriate, she could lose her job. Only your doctor can calm your fears and reassure you about your pregnancy issues in a way that no one else can. Your results are part of the sacred and private relationship between you and your doctor!

Finally, on to end on a positive note, most of us are more than happy to educate you about what you see on the monitor (minus a diagnosis!). I loved sharing how we measure and pointing out all your Baby’s parts for any inquisitive parents or family.

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Your questions and comments are welcome at wombviewerblog@gmail.com!

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Posted on July 12th, 2014 by wombwithaviewblog.com

Technology has its pros and cons. We THINK we want to know the second we conceive…but do we really? When all we can see is early first trimester sacs, your doc cannot confirm the pregnancy is off to a good start. At least not until we can see an embryo and strong heartbeat at 6 Weeks. Some patients find out that (often times) ignorance is bliss. The wait is long and miserable! This is why your doc will elect to scan you around Week 7 or 8.

Early First Trimester Sacs – Week 4

Very early in the pregnancy, less than 4 Weeks gestational age, we can’t see a thing. To clarify, we start to see a gestational sac at around 4 Weeks. This sac will measure only about 2mm and will literally appear as a tiny black blip within the uterus. All we can report at this time is that we think it’s an early sac.

Week 5

Monumental changes are happening every week!  At 5 Weeks pregnant, we see a much bigger sac. However, it’s only enough information to say, yes, the sac has grown, it measures around 5 Weeks, and that is good. Around 5 1/2 Weeks, we should see the presence of a yolk sac. It looks like a little circle inside of the sac and provides nutrients for Baby who is still too tiny to see by ultrasound. Below is about a 5 1/2 Week pregnancy of twins (obviously! Dichorionic/Diamniotic or fraternal).

Yolk Sacs, 5 Weeks pregnant, twin pregnancy, early first trimester sacs

 

Week 6

6 Weeks pregnant, 6 Week ultrasound, 6 Week embryo

By the next week at 6 Weeks gestation, an embryo measuring about 3.5mm with cardiac activity should be seen! A nice, round yolk sac and a bigger gestational sac factor into what we expect for this exam. Baby is still very tiny, and it can be difficult to visualize well if the embryo is lying against the wall of the gestational sac.

At 7 Weeks we can see a little better, and Baby is a few mm larger. But 8 Weeks usually gives us a great image of what we want to see!

Week 8

Baby, on your 8 Week ultrasound, is much easier to measure at this point.

8 Weeks pregnant, 8 Week ultrasound, early first trimester

Isn’t the growth in two weeks incredible?!!!

It’s all a process of Mother Nature. It can’t be rushed, and only time will tell if your pregnancy is growing appropriately! If you think you are farther along by your LMP (last menstrual period) dates, we perform an ultrasound, and we don’t see what we expect, it can feel like such a long wait! There’s no way to know whether the pregnancy may not be progressing normally or whether you may just be too early!

It’s so hard to wait. And it may feel like the longest week or two of your life before your doctor orders another scan!

What most women do (and I caution you to not!) is to talk to friends and family and search Dr. Google furiously for what to expect. Only no article or blog post can predict the outcome, and only that next scan will (hopefully!) give you answers.

Here’s sending you best wishes and much-needed patience to all you expectant moms out there!

Email me at wombviewerblog@gmail.com with your questions or comments:)

 

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Posted on June 29th, 2014 by wombwithaviewblog.com

Internet Pregnancy Advice Isn’t Always So Reliable!

I know it’s such a difficult temptation to resist, but Dr. Google really isn’t the best doc to consult when you’re experiencing questionable symptoms. Especially, not when it comes to pregnancy, and practices across the country see it every week. Relying on Dr. Google for internet pregnancy advice only opens a can of worms causing more fear and worry…and more questions.

We’ve probably all done it at one time or another. Isn’t it just so easy to click on a Symptoms Checker or post your question onto your pregnancy group’s community forum? Maybe someone else has experienced the same thing, it turned out to be nothing, and your fears can be put to rest? The problem is that no one else in the world is you — or your baby.

We would see this quite a bit in the practice I worked for — a patient is given ultrasound results by her doctor, she goes home to Google the information, and then calls back to the office in a complete panic over what she’s read. The internet is filled with more information than we need and more than applies to you in your pregnancy. You are likely causing yourself more worry than necessary.

TMI

What you’re getting in your internet searches is the whole spectrum of findings and worse-case scenarios. This is also the case on almost every blog and site, no matter how credible. In your forums, you have other pregnant moms with no medical background, all discussing their results with only partial knowledge of her case and missing links. At the end of the day, twenty people experiencing pain may yield seven different outcomes. And because people gauge their symptoms differently, there’s no way for you to compare their level of pain to your own.

You know, as humans, we’re a bit flawed in our thinking. We tend to convince ourselves of what we believe to be true, whether that information holds water or not. The last thing you want is to read something which convinces you that you don’t need to call your doctor when you really should have. Don’t convince yourself a problem isn’t real; let her staff ask the important questions and determine whether you need to be seen!

The Best Advice!

Your doctor is your best resource for managing your pregnancy and any potential problems which may be associated. Only she/he holds your chart full of pertinent medical information about you and your baby. Your obstetrician can examine you and listen properly for your Baby’s heart tones or perform an ultrasound. Only your doc can advise you on what the next step should be or determine if ordering further testing is warranted. Whatever your concern, discuss it with your obstetrician or other healthcare professional managing your care.

And in case you’re more concerned with bothering your doctor after hours, this is precisely the reason for on-call staff around the clock! Your physician is your best advocate. He would rather you ask him (or his qualified staff) than your friends or family.

*FYI*
If you begin to experience your symptoms early in the day, don’t wait to call until midnight!
(To clarify, this doesn’t mean not to call because it’s midnight — just not to wait!)
 Don’t wait to see if your problem will go away. They’ll want to know about it sooner than later!
Also, you don’t want to put off treatment if you need it.

Remember this. Dr. Google cannot lay hands on you, examine you with his handy-dandy speculum, advise you, console you, or discuss test results. This is why you have an obstetrician. Moreover, Dr. Google didn’t attend so many years of medical school and surely won’t be the one to catch your precious bundle of joy on his or her birthday.

Direct all your concerns to one who will be — that’s why she’s in the baby business!👶

You can email me at wombviewerblog@gmail.com with any questions!

 

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Posted on March 1st, 2014 by wombwithaviewblog.com

What exactly do I do? Let’s break it down. This information will definitely be helpful to anyone interested in training for a career as a sonographer. Many are fascinated by ultrasound! So, this may also be an interesting read for those who are merely curious about what we do. This may also be a little long, so hunker down with a good cup o’ joe.

Ultrasound is very technical, so attention to detail is of great importance. We work in the millimeters, so spacial concepts and 3-dimensional thinking are necessary. We can visualize mentally what we are only partially seeing on the monitor. For new sonographers, this gets easier with improved scanning ability over time. None of us were great sonographers right out the gate!

So, what am I? I have many names…sonographer, ultrasound technologist, ultrasound tech or technician. A certified sonographer is someone with a couple of years of experience who has passed a Physics exam and one specialty examination (like OB/GYN). You then earn the credentials of RDMS, Registered Diagnostic Medical Sonographer. There are many other examinations for which one can earn more credentials.

We start off with some book knowledge. We learn medical terminology, A&P, pathology (disease) and how it presents, ultrasound physics, biology, and examination protocol, for example. In my particular training, we started clinical rotations where we visited different clinical settings for a period of time. We would follow other more experienced sonographers to observe examinations. I learned a little about the technologist/patient relationship like what to say and (most importantly!) what not to say.

We also learned how to present our examinations to the Radiologist, the reading physician. You better have all your ducks in a row here, people! They are tough. They can and will ask you a hundred questions, and you better have the right answer waiting. Like any other profession, some are easier to work with and offer more guidance. Some, well..don’t. After you are more experienced and have proven yourself time after time, the tough ones let up a little:) They know when a sonographer knows her stuff, and they know when they can trust your skill and ability. It just takes time.

We learned how to handle patients in hospital beds, how to transport them, and how to handle their catheters. Learning to keep urine, vomit, or blood off your person was a good time, too! We also learned what to do if it happened anyway and how to not get sick yourself. It doesn’t help your patient! If you have a good teacher, you also learn how to handle patients with dignity and respect. It’s hard for someone to feel that when they lie in a hospital bed. In an outpatient setting, you learn that patients are the lifeblood of a practice. When dealing with the general public, you can’t always say what you want, and you have to learn to filter.  This is sometimes VERY HARD to do!

A sonographer learns scanning ability with hands-on training with a machine and an experienced sonographer at the helm. Ultrasound machines are very much like most computers. They all have the same basic functions, but some have a few more bells and whistles than others. We learn what something looks like by watching someone else.  S…l…o…w…l…y over time we begin to be able to recognize parts ourselves. Then we take over the probe. We have to learn how to hold it and find the parts ourselves. We learn how to properly measure organs and how to adjust 40 knobs so that the image looks the way it should. Additionally, we have to learn image protocol which includes what images to take and how many.

Eventually, after a few months of scanning, these technical details become second nature. As soon as the probe touches the skin, we set about making our image look as needed without much thought. It is only then that we start to recognize pathology. Sometimes, disease processes present exactly as one learned from the book, sometimes not. Oftentimes, we see something we know is NOT normal, but we can’t exactly put a name to the process. What students need to know is that one of the most important things they’ll learn about ultrasound is to first learn what “normal” is.  Once one scans many normal exams, it is much easier to recognize when something is wrong.

We learn all the above for many different parts of the body! Some aspects of ultrasound include Intracranial and Peripheral Vascular (vessels of the arms and legs), Echo (the heart), Small Parts (breast, testicle and thyroid), Abdominal (all abdominal organs and vessels), OB or Obstetric (maternal and fetal), GYN or Gynecology (pelvic organs in a non-pregnant female), and many others. Ultrasound is also performed on the eyes and in more recent years, muscles and nerves. We also spent a bit of time learning about biohazard waste management and HIPAA regulations that keep patient information private.

Over time and with more experience, we learn how to better manage our patients and case loads. I say it’s a process with a long learning curve, especially for anyone starting out with no medical background. At times, I cursed my choice of career, place of employment, and certain unpleasant physicians. I sometimes cried before and after a particularly hellish workday or weekend of call. It was the hardest thing I’ve ever done. BUT I did it. And slowly but surely, the puzzle pieces came together. They began to fit in a way that brought light and clarity to every exam I performed. Suddenly, it just started to make sense.

When I began to ask more questions about something I didn’t understand, I received better response from docs I admired for their extensive education, intelligence, and knowledge. You can’t be afraid to ask questions! It’s important to your docs, their practice, and patients. It’s also important to you, the sonographer, for your own developing skill and ability. This confidence grows over time! It’s a great feeling when you finally get to this point.

To this day, I still get a rush when I recognize pathology and all the puzzle pieces come together. It makes me happy when I can explain something to a patient that gives clarity to her understanding. There’s nothing like a “thank you” (or even a hug!) by a patient. And who doesn’t love positive feedback by a physician who says you did a great job? As difficult as my career was in the beginning, I’m still at it after 23 years. And year after year, post all the blood, sweat, tears and pain, I feel I’ve come a long way:)

 

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Posted on November 23rd, 2013 by wombwithaviewblog.com

Who Should Consider Their Patient Relationships?

Anyone in health care, actually. But this one is for sonographers. I thought initially the patient might glean something from it, also, to understand what it is she should expect from her sonographer.  However, I quickly realized this isn’t something the patient needs to read to understand…it’s something she already expects. Every patient who walks into your room expects to be greeted kindly and with a smile. She expects that her examination be explained in a way that she clearly understands. She expects to be treated like a fellow human…and she deserves it.

Your only job isn’t to only look at the monitor.

You have to get out of the mindset that your only job is to look at that monitor and say nothing else to your patient beyond an explanation of exam. She has feelings.  Sometimes, she is even frightened and anxious about the examination she is about to undergo. Who really enjoys their feet in stirrups?

Sometimes, it’s not the examination she’s afraid of but the results. She’ll often even tell you so. You are the provider. You are the master and conductor of the environment in your room at that moment. You have to keep in the forefront of your mind that the exam you are performing requires “invading” the personal space of another individual and actual contact with that person. The exam is a very personal experience for that patient and, often, a very uncomfortable one. Your patients trust that you will do a good job for them because you are a representation and extension of her physician.

How To Break the Ice

You can ask her how she’s feeling today. If she says, “Terrible,” you can lend apologies and say you hope her day will be better as soon as the test is over! Patients often laugh at this as I’m gelling up the middle finger of a vinyl glove and slide it down over the vaginal probe. I always say, “Gotta have a little comedy in medicine somewhere, right?!” They’ll ask about your family, pictures in your room, your kids, your experience in your career. Talking to them during the exam helps most people to just get through it a little more easily.

Don’t be afraid to open a conversation for fear of being asked the question we all cannot answer — the one regarding results. The best way to respond to this is to simply state, “Well, my job is to take these measurements and images. Your doctor will want to examine them along with your other clinical information and then decide how your ultrasound fits into that picture. Only your doctor has all the pieces of that puzzle!”

For obstetric patients, you just about can’t get through an exam without Mom or Dad asking, “Does everything look ok?” I’ll usually say, “So far, so good! But, you know, your doctor will go over this entire exam with you, and you can ask her any questions you have.” I always found it helps to point out their baby’s parts as you take your images. Thank the heavens for post-processing, right? You can always go back and focus on things that need special attention after your patient leaves.

My Best Advice

There’s one really important piece of advice I’ve learned over the years. Anyone who works with the general public would agree that you can’t make everyone happy all the time. It’s just impossible. But it doesn’t hurt to try! Some people can’t be made happy. Try anyway. Go out of your way to make conversation with your patient. Make her feel comfortable and answer her questions that you can answer. She’ll leave feeling like you’ve given her an adequate examination. At the end of it, she may not even mind so much that she needed it to begin with.

It feels good to receive a warm “Thank you” and smile as you walk your patient out. If you can send her out with a good chuckle, even better. 🙂

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