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.