Ebola, And Gil Mobley: Editorial

Ebola, And Gil Mobley: Editorial

I know Gil Mobley.  He is a good person.  He is a great physician who does great work.  He has been in the news for donning a TYVEK suit and walking through Atlanta's Harts field airport.  I know him from some work we did together in Guatemala.  I think his comments are correct about the CDC.  His antics are a wake up call.  Gil Mobley is an intelligent doctor, and he spoke his heart.  I work in education, and patient care.  We should all wake up to his clarion call, and realize this virus takes no prisoners.  Gil Mobley was one of my students.  I taught him basic ultrasound skills in Houston Texas.  Gil, God Bless you if you see this post after the media frenzies.   TJW  Here are some links:

PHILADELPHIA (CBS) – Dom Giordano talked with Dr. Gil Mobley, who believes the CDC is lying about the threat posed by Ebola and staged a protest at Atlanta’s Hartsfield-Jackson Airport to expose it.

Thanks CBS and Dom Giorino

Credits:  
http://philadelphia.cbslocal.com/2014/10/03/missouri-doctor-its-just-a-matter-of-time-before-ebola-is-carried-to-every-corner-of-the-world/

Cardiologists Who Use An Ultrasound Machine To Examine A Patient?

Cardiologists Who Use An Ultrasound Machine To Examine A Patient?

It is Saturday.  My wife and I are sharing our twentieth wedding anniversary by going out for dinner.  I was cruising through all the doom and gloom of Ebola, and other stuff, and discovered a notable.  A cardiologist using an ultrasound machine to check on a patients heart.  When most patients come to the cardiologists come to the office, they get an ECG (EKG), and the usual vitals by the nurse.

I think that it would be great if a cardiologist TRAINED in BASIC echocardiography would use the machine to take a look at the patients heart.  A basic echo would assess cardiac output, wall motion, and other factors like valvular incompetency.  The machine to the left is not an ad.  It is one of several machines used in offices around the globe.  I think the cardiologist should use this tool in a BASIC examination of the patient in the office.  Question: reimbursement.  Oboma care?    We will see how that shakes out.  Here is a link to a useful article.

Cardiologists who used a handheld ultrasound were more likely to make an accurate diagnosis of patients with common cardiovascular abnormalities than colleagues who relied on a physical exam, for an estimated savings of $63 per patient. Handheld ultrasound’s ability to rule out abnormalities also likely would reduce downstream testing, according to a study published online Sept. 17 in the Journal of the American College of Cardiology: Cardiovascular Imaging.

Sonography Will Be A Great Job In the Future

I have an article here which is optimistic.  In this time of misery in terms of employment I hope the predictions are correct.  BTW, I am a teacher of sonography, and I am looking for a FT job.  If any of you readers would like to hire me, please contact me at gallgizzard@gmail.com   Thank you. Happy holidays and be safe driving.

According to a five-year jobs projection report from CareerBuilder and Economic Modeling Specialists, 26 of the 50 jobs projected to grow the fastest from 2013 to 2017 are in the healthcare industry.

The jobs range from high-skill jobs like occupational therapy to lower-skill personal care roles.

The following are the 26 medical, allied health or health-related jobs projected to grow the most in the next five years, listed by percentage growth:

1. Biomedical engineers: 23 percent change
2. Personal care aides: 21 percent
3. Home health aides: 21 percent
4. Physical therapist assistants: 16 percent
5. Occupational therapy assistants: 15 percent
6. Diagnostic medical sonographers: 15 percent
7. Medical scientists (except epidemiologists): 15 percent
8. Physical therapist aides: 15 percent
9. Medical secretaries: 14 percent
10. Nurse midwives: 13 percent
11. Nurse anesthetists: 13 percent
12. Audiologists: 13 percent
13. Physical therapists: 13 percent
14. Marriage and family therapists: 13 percent
15. Emergency medical technicians and paramedics: 13 percent
16. Dental hygienists: 12 percent
17. Nurse practitioners: 12 percent
18. Health educators: 12 percent
19. Mental health counselors: 12 percent
20. Healthcare social workers: 12 percent
21. Occupational therapists: 12 percent
22. Ambulance drivers and attendants: 12 percent
23. Occupational therapy aides: 12 percent
24. Medical equipment repairers: 11 percent
25. Cardiovascular technologists and technicians: 11 percent
26. MRI technologists: 11 percent

Here is the link.  Thanks Sonoworld

http://www.beckershospitalreview.com/workforce-labor-management/26-healthcare-jobs-among-50-projected-fastest-growing.ht

I picked up this lengthy article out of curiosity.  I subscribe to many blogs, and I am always the cat looking for the bug in a dark corner.  The reason I re-post this article is because nobody I know has published any data on the long term effects of the drug known as ketamine.  I know it increases heart rate, and BP, but who knows what the lasting effects are?  I have never taken this drug, but I have seen it used in the early 1970's on old patients in surgery.  I was appalled.  These patients were not "OUT" they were mumbling and groaning.  I thought it was barbaric.  How does this drug which many asians take daily affect them?  What diseases and conditions are we missing?  Drug use in China is on the up-surge.  This indeed an interesting topic.  I am sure many of you will comment.  Great.

The first thing you notice are the straws: long, bright, pink-and-purple-striped, with bent necks reminiscent of childhood parties. They’re all over the place, on benches, tables and trays, being passed around like lemonade. Otherwise, the room is exactly as you’d expect a private karaoke room would look like in Guilin, known as south China’s most beautiful city, if you were to wander in at two in the morning.

A rumpled Taiwanese businessman makes eye contact. As his friends gear up for the next big song, he enthusiastically bids me enter. There’s a lot of collar loosening and hugging, flabby, middle-aged male bellies and toasting. A couple of women have lost their tops. Everyone takes a big hit of the enormous lines on the tray, and then they ignore me.

http://motherboard.vice.com/blog/the-great-k-hole-of-china

Thanks Joann

Let's look at Pericarditis in a New Light

The patient depicted to the left has hepatitis.  He also has pericarditis.  The echo diagnosis is pretty hazy.  We look at the pericardium, and usually look for anechoic space between the epicardium and the pericardium.  when we see a separation on M Mode or 2-D we call that out.  We have no idea what is going on until we do a pericardiocentesis.
here is a post to a link to the PDF that explains the new guidelines.  This is a must see for Echocardiographers, and Cardiologists.  Thanks ASE.  I am a Fellow there. :)

Be well all.  Here is the link.

http://www.asecho.org/ase-guidelines-by-publication-date/

Follow the link for the PDF file

Thanks ASE.  TJW

Echocardiography Underwater

OUCH!  An article I will link reveals that scuba diving may be hazardous to divers older than forty years!  I have been a diver since the age of 16, and this is NOT good news.  Both my wife and I are certified divers.  I have logged hundreds of dives, and only had one emergency, which I dealt with as you can see.  To become a certified diver, one must undergo rigorous classroom, and practical experience.  I am fortunate enough to have been trained by a late student of Jacques Cousteau in the early 1970's.  The traditional and flawed bi-tubed regulator was replaced with a single hose regulator around then.  I was trained how to calculate diving times by depth charts, thus to avoid many horrible medical conditions caused by early de-pressurization.  The curriculum includes many issues as relates to health and safety.  All programs are centered around safety including the buddy system, emergency procedures and basic first aid.  I saw first hand 8 years ago what happens to a diver when they do not follow the rules of decompression.  My wife and I were on a cruise to the caribbean, and we took a sport dive near Roatan.   We dove in calm seas, and 45 minutes later rose to find the seas were troubled by ten foot swells, and dark clouds with windy conditions.  Tropical Storm!  We quickly got on the dive boat with horrible thoughts about getting shipwrecked.  Nobody said anything about a possible tropical storm.  We chugged back to Roatan fighting waves the size of  humpback whales, and made it to the cove in time to see another dive boat dock.  As we were carrying our gear towards Antony's Key Resort http://www.anthonyskey.com/diving/dive-operation.htm  We spied a gurney with a diver on it being pulled towards the recompression facility.  We watched in horror as the diver was convulsing on the gurney, and all that diving training came back into my mind.  Diving is serious stuff.  My wife is a nurse, and she had a fit as this guy was pulled into the medical facility.  Did he survive?  We have no idea.  The most probable explanation was the dude surfaced too rapidly because of the weather. This was certainly a dramatic part of our vacation.

So what about my emergency?  I bet you are waiting to hear my story.  Simply put, I started after a manta ray (docile and looking like a Klingon Warship) wanting to ride it.  I have ridden a manta ray once when I was younger.  The are plankton feeders, so no teeth to worry about.  I descended too rapidly and became hyper-ventilated.  The dive master realised my issue and assisted me in a controlled ascent.  It was an emergency.  I got on the boat and breathed through a paper bag for a few moments and got back in the water knowing that if I did not attack my fear, I would never dive again.  That happened 30 years ago.  Good training is key.  I recommend sport diving (Not cave diving, which I have done) to all who are trained rigorously.  Here is the link to the article I mentioned at the top.  Thanks for your time.  TJW

Scuba diving is growing in popularity among older Americans and heart attacks and unknown heart rhythms are the most common cause of diving-related deaths after age 40, according to the Divers Alert Network, a nonprofit research group.

The study, conducted in Italy, involved 18 scuba divers, including 16 men and two women. The participants were about 42 years old and each had made at least 100 dives. None smoked or had hypertension, heart or lung disease.

http://online.wsj.com/article/SB10001424127887324324404579045020481386890.html

Thanks WSJ

Echocardiogram: Basics

The first thing I teach my students is probe orientation. Know the human heart.  The probe must correspond to the anatomy.   The heart is not square with human anatomy.  It is in a strange plane.  Most human hearts sit at a 45 degree angle to the chest, unless you  are hypersthenic, or hyposthenic, your heart is in a predictable place.  Performing an echocardiogram requires a ZEN mind set.

Orient yourself to the plane of the heart and observe. We must be free of the telephone, and the buzzing of our stomachs.  I refuse to answer a phone in an echo lab.  Most Admins understand this.  First:  Look at the heart.  Adjust gain and depth.  Then just look and let the patients heart become part of you in a professional way.  Look without any prejudice.  The worst thing an echocardiographer can do is judge a person based on social criteria.  YOU KNOW WHAT I MEAN.  This does not preclude a great history on the chart or in oral questioning.  I never start an echo without chatting with my patient about history etc.  Body habitus is everything.  A smoker will likely require many sub-costal images, a well-nourished patient may need a higher probe position near the left axilla.  Many Americans are obese, look at it as job security.  But on occasion you get a skinny person. They are hard to scan because of the nervous nature.  Not a bad thing IMHO.  I Love all my patients thick or thin.

Be at peace, and make a professional analysis of this person's heart.  Do it with total concentration.  Make accurate measurements.  If you cannot make an accurate measurement, tell the cardiologist on your technical form.  The planes of the examination are for most part PSLA, PSSA, APICAL 4, 5, and Apical 2 chamber and 3.  The substernal views are great for PE's, and ASD, VSD, and the pulmonary trunk.  Do not forget the supraclavicular views for AI and AS.

Once more, Concentrate.  This person's heart is in your hands.

PS:  I blog when I am Damn Well Ready.  Most writers will tell you they do not write when they are not in the mood.  My blogs are from the heart.  I write when I am in the mood.  Blessings to the Hemingway, you old sot.  Rest in Peace, and do not be so down on yourself Earnest.  I can do that for you.  I am my own worst critic.  TJW

PPS: the picture is of my cat dressed up in frills by my wife of 17 years.  My wife is a silly person.  I love her very much.  I would never understand her in a trillion years.  My wife is my first and last wife.