Chasing Bluebirds

my kind of patient

this guy paid me a visit today at work, he hung out for quite awhile, squawking and tapping and making a fuss. i hope he comes back tomorrow! (you know it could be a she!) whatever.

tomorrows friday! hooray!

art:work

taking my camera to work is turning my blog into a bore, sorry. :)

work

just call me pat (thats who i "am" right now, get well soon pat!xoxox)

so you want to be an ultrasound tech? breast imaging 101

i guess i have neglected this part of my blog, the "career" part where i thought i would give great useful advice about being an ultrasound tech and found that i was just a big whiney burnout when i went down that path. i am one of those people who gets around a bunch of complainers and i happily join in until some cheerful person puts me in my place, then i realize i need to be thankful and all that, blah blah blah. 

anyways, i have so many highs and lows with my job, i think the roller coaster ride keeps me from getting bored, but it can really wear me out too. for one, i see sick people all day who by their very nature are cranky. then, if i am around pregnant women all day, there are serious hormones raging not to mention the "this is the most exciting wonderful scary wacky crazy maybe stupidist thing i have ever done to myself" thing going on. so, here i am just scratching people off a list to get to a lunch break or to get home to my family and i have a person in a crisis of some kind, one after another. i have to read minds, read a blurry image on the screen, diagnose for the doctor (and sell my work to him/her even if its crappy) and then make absolutely certain i dont tell the patient too much (practicing medicine without a license, a big no no) or be too robotic and "mean" getting myself a patient complaint. personally, i dont have a problem telling a patient my opinion, exactly what is wrong with them, if i think they need a new doctor or if they need to see a shrink, but if i want to keep my job, i have to be very very careful. this to me, is the biggest dilemma i face. what to say and how to say it.

recently i have been at a breast imaging center, covering for a tech who broke her scapula (ouch!) anyways, now that i am getting into the "older lady" crowd, i find so much more in common with all the women there and so much more compassion for what they are going through. you see, when a person gets a mammogram, they may or may not realize the actual "process" they are going through. i want to get it out to everyone, because i have found many people thanking me for just plainly explaining what breast imaging is all about. 

so here goes: unless you have a strong family history of breast cancer and/or other factors your doctor can explain, you need to start at age 40 with your annual mammograms. luckily for women today, you can choose a breast center, which is a place that does only breast imaging. i recommend a place like this where the radiologists specialize in reading breast exams. mammograms work by comparing one year to the next, comparing you to yourself, year after year. the subtle changes in your breasts will alert the doctor to something that may or may not be cancer. if there is anything strange found on your "screening" mammogram, which is just a few views taken quickly on each breast, then the doctor will recommend additional views. this happens every day, is very common, is just a second look. when the mammogram tech squishes your breast in the machine, it makes patterns on the image, if there is a mass, no matter how many times or positions they squish you, it wont go away. so, if they take a different view and it goes away, it is likely just normal tissue bunched up in a weird way. 

now, ultrasound, sometimes looking with ultrasound will help by finding a cyst (super easy to see on ultrasound) or a solid, easy to see mass or sometimes a cancer can be seen. the most important thing to me is that it all works together for the most part. yes, there are people who come in, they have a screamingly obvious cancer which is quickly found. but most often its a small suspicious thing, maybe additional views are taken and it still looks weird, an ultrasound shows it is suspicious... now what? a simple biopsy (which thankfully is so fast and easily done nowadays) can take the tiniest piece of tissue and a diagnosis quickly made so the patient can get treatment fast. this is how it works. it shouldnt be horrifically scary, it should be something we all have to do every year, just like our paps so we can give ourselves the best odds of finding something bad early and fast. this all may sound simple, but i get so many women who tell me they didnt know the importance of going to the same place every year or if youget your films if you move because the radiologist will be comparing year to year to year. thats how the science of diagnostic breast imaging works. also, we now have MRI's of the breast which are another tool used to find breast cancer and can be a great benefit for early detection (i am not a pro on this because it is out of the realm of what i do, but usually MRI's are for people with known cancer to analyze it better and/or for following up after the cancer has been removed).

when a woman is young, her breasts are firm and nice and all that good stuff. on a mammogram the breast of a young woman is too dense to see through easliy, this tissue can hide a lump or mass. an ultrasound can sometimes find a mass in a young person better than the mammogram, but it can still be tricky. this type of "young" breast is called "fibrocystic" tissue and many people tell me they have "fibrocystic disease" which in fact is very common and at least to me, isnt really a disease. (frankly i cringe at the word "fibrocystic" because it has so many different meanings)  i just wish the doctors would explain this better to women so they dont run around thinking they have some kind of disease, breasts are glands and they get sore and respond to hormones in your body. i cant tell you how many people come in with the complaint their breasts hurt every month around their period and are concerned something is wrong. so, young breasts are just plain difficult because of the very nature of young breast tissue, it is lumpy and bumpy. this means young people really need to be diligent in checking each month, feeling for lumps and bumps and to never be afraid to go to the doctor if they think something feels different. remember "young" means up to 40 years of age, to me anyway, and some people have lumpy, dense breasts even after 40. 

as we get older, our breasts usually get more fatty and loose and hangy (all crappy stuff but you know what??) mammograms love fatty droopy breasts and can see right through them making breast cancer easier to find. this is the only good news i have ever heard about getting old, saggy baggy breasts, yippee! at least a little good news there. so everyone needs to feel good about getting their annual breast exam, a mammogram for sure after age 40 and go every year. dont be worried if they call you back, they just want to squish you a little more and their goal is to find something small, the doctor looks very closely and i have never met a radiologist who doesnt take breast imaging very seriously (and they are PICKY and conservative usually) which is a good thing for the patient, a grind for the tech, but hey! most of us dont mind too much since our goal is to send a patient home with an accurate honest result. right?

whew! the reason for this long post? well i have had a more than the usual amount of people asking me how to become an ultrasound tech, if i like it, isnt it fun? and i always tell them "do you REALLY want to know?" it can be so icky and sad at times. being at the breast center has reminded me to be more compassionate and i have had some really nice interactions with my patients, lots of thank-yous and hugs and even a few tears too.  instead of feeling like i am doing a thankless job, i have had some nice feedback. so i guess i just needed to find my niche, for now anyways.

ok, on a more summery note: a few pictures of a great ride down to the beach we took one evening this week (12 mile ride!)

here's a breast cancer link that came with a comment made on this post, it was pretty interesting.

so what did you do today?

people often ask me how my work schedule "works" so i thought i would try and explain it. a couple times a month i get a call from my "boss" and she tells me what hospitals, clinics, doctor's offices need coverage for the next month (vacation, maternity leave, vacancy when someone quits). the work can either trickle or flood in. i try my hardest to work part time, but lets say someone wants a two week vacation covered, i usually have to do the whole two weeks. so i will block off time around it to get stuff done around the house and spend time with the family. my kids have to be in full time daycare, even if i don't use it all because my hours vary so much. when the work is super slow, i find myself having to work graveyard shifts (HELL!!!) and taking call (triple HELL!) and going to super poopy places like beverly hills and santa monica (quadruple HELL for sure, sorry if you live there but traffic SUCKS!) i work with a group of techs and we all share the work, taking turns at places we might not want to go to, but we work together as a team. i like the ebb and flow of the work, some places i like better than others. some places are challenging, but i know i need the discipline. sometimes i work too much and then i cut back the next month, i can do that. which i like. so, today, there was a mixup (my fault) and i had no real plan for the day (nice!)

ok, so what did i do today on a scheduled work day that became a day off last minute (oh, i forgot to mention i actually have a wee account to cover tonight, but thats only for two hours about two blocks away, EZ!) well, i spent some time making this:

the inside is absolutely wacked out polysester (someone will have a gift waiting for them in their mailbox today)

and this:

first time i EVER sewed a zipper, so proud! this bag replaces this:

i hope this is small enough so you don't gag when you see it. my temporary makeup "bag" was way past it's prime!

cleaned up the pad (notice beach towels dry on the elliptical trainer and you can't see the crap stacked by the front door, careful angling with a bit of blur)

spent many more HOURS than i thought it would take to email my local city council members to stop the building of a home depot down the street, oh and "save the wetlands" mention too.

i did manage to have a special breakfast with emily before she went off to camp and spent time chatting with nancy and bill (who take care of lizzie and will be greatly missed when we start preschool in sept, don't worry we'll visit!!!) and now, a quick walk with the dogs, pick up kids, visit and kid drop off to grandparents and off to the two hour gig down the street. hope i can get to the wetlands meeting for the last hour of it, did i say this was a day off? geez!

flickr favorites... recovering from a graveyard shift

Whitstable: Cottages (County of Kent UK), originally uploaded by steffanmacmillan.

Whitstable: cottages (county of kent, uk)

when i have to work a graveyard shift, i am such a zombie the next day... finding solace in some cool flickr photos... doesn't take much effort to look through all these lovely images. :)

just another day at the office, you STILL want to be an ultrasound tech?

see this?

so you see a baby in there? don't worry, i can hardly see it myself.

this patient came in today, excited for her ultrasound, wanting to know if it was a boy or girl and STRESSING that her mother (waiting patiently in the waiting room) REALLY wanted a girl. ok, i thought, wondering if i was going to be able to see ANYTHING at all being that this patient was on the chunky side. but, ok, let's give it a try. luckily for her, i felt pretty confident that this was a baby girl. let me also say that i NEVER guess, i only say when i feel pretty certain.

well, the mom comes in and the daughter plays some guessing games with her and everyone is laughing and everything seems fine....this grandma REALLY wanted a girl. so she got her girl BUT, she still has to ask me a dozen times more and then shouts out randomly "oh! i see balls! oh no! i see balls!" as i am scanning (sorry but "balls" is just tacky). ok....deep breath, almost done, everyone seems happy....last picture, last check for baby girl parts...done! daughter is off to the bathroom.

now, what does her mom do? she asks me a couple more times if i am SURE it's a girl, what is the percentage of a chance it might be a boy? i tell her it is always 50/50... we just tell the patient what we think, there is no guarantee...blah blah blah...help me! the final question: have i ever been wrong? well, i say, i have never had anyone come back and TELL me i was wrong so i am not sure...and she says (grabbing my arm) "you wanna know something? if you are wrong about this baby, i WILL come back, you can bet on that." and i am not kidding, it was like out of a movie or something, she had a little glint in her eye and added a little hee hee...not kidding type laugh.

holy crap! get me out of here! daughter comes out of the bathroom and off they go.

now thinking about it later i feel pretty ticked off, i dont have to tell a patient whether they are having a boy or a girl, that's a courtesy. it is not part of my diagnostic protocol to sex the baby, it is only important for twins and for people who carry genetic malformations that are sex-linked. geez people, now i have to add "fearing bodily harm if i make a mistake" to my list of worries...thanks a lot. i have an ultrasound friend who NEVER tells the patient what they are having, never ever. she was sick and tired of this kind of wacky patient and family. i always thought she was hardcore over the top, but i think i am moving in that direction myself.

:)

back to work i go!

a good laugh

lauging baby

the joy of ultrasound

yes, these are questions i have been asked by ob patients:

1. can you tell the color of the baby's eyes?
2. can you tell the color of the baby's skin? (the patient is trying to narrow down the list of possible fathers)
3. can you tell me EXACTLY how many weeks pregnant i am because if i am 6 weeks the baby's daddy is "A", if i am 8 weeks the baby's daddy is "B" and if i am 10 weeks the baby's daddy is my husband who is in jail and will not be happy about this pregnancy.
4. tell my husband the baby is a boy no matter what because my husband will not allow me to have another girl.
5. is it ok that the baby is drinking the water? (when told the baby is drinking the amniotic fluid) won't the baby drown????
6. can you tell the doctor i am further along, i dont want to be pregnant anymore (a 19 year old who was SERIOUS!)
7. you are sure there aren't two? (i hear this daily, especially funny after i have done the show and tell and the patient is walking out....oh yeah, DUH! i forgot to tell you there were two...oh, by the way...you are having twins...uh.....oops...forgot to tell ya there are really two babies in there, i just only showed you one because...uh...er...)
8. are you sure it is boy (or girl) after being told a half dozen times. it is much easier to just say i can't see, but i really am trying to be nice! if i say its a boy, show you a penis, point it out, take a picture, say it a couple dozen times........it's not a girl, ok?
9. do i like kids, have kids, want kids on the planet? (people reallly do ask me daily if i LIKE kids...what does that mean? yes, i like kids, my OWN kids)
10. do i LIKE scanning babies all day? yes i like scanning babies, yes i really do...it's the mom ATTACHED to the baby that bugs me. ha ha!!!

oh and one more question i recently got: "can diet pills cause brain damage? i took diet pills for the first six months of my pregnancy to keep my weight down" uh.......are you kidding me??? is this the kind of person who should be having a baby?

oh...one more! i had a 16 year old (yes 16) who came in with her mother(about my age) who had just had her own baby (so this is the grandma...holding her own newborn which is my patients brother). they are both super excited for this new baby and my patient takes down her pants to reveal her "boyfriend"'s name tatooed across her pubic area (yes it was LOW) and this boyfriend finally shows up at the end of the exam, gray haired, at least 35 years old if not older...and everyone is so HAPPY! i am thinking, ok, this 16 year old girl is branded and having a baby with a guy old enough to be her dad and her mom is overjoyed and i just need to get a new career and fast!

let's lighten things up!
a set of twins bonking eachother, this was actually kind of neat...i am sure no one was injured in case anyone is concerned.

an arm and a lens

(disregard my lovely spelling, that is supposed to say "arm") photo one is a front view of a baby face with his/her arm in front, eyes are closed and puffy. photo two shows a nice front shot with the lens visible within the eye socket (this baby looks like it is smiling too).