How to get an ultrasound screening with CMD
Please call and make an appointment vs walk in's.
The reason for this is that we are able to see up to 16 patients per hour however we prefer to see 12 per hour so that patients don't have to wait long. We book in blocks of 12 per hour. So you will be seen on a first-come first-serve basis in the order that you sign in within that hour. So you don't have to be at your appointment at the top of the hour.
If you decide to come in early before your blocked appointment, your worksheet will be put aside until that hour arises to be seen. In other words you will not be seen before your scheduled time. This gives our tech's an opportunity to take a breather before the next wave of patients arrives.
We accept all credit cards, cash or checks. Credit cards have an additional $2 fee. We don't except out of country checks.
Avoid large meals before the screening. You can eat and drink, Just keep it light. Please shower or bathe. Lotions, Perfume and Cologne are excepted. Jewelry is excepted. Wheelchairs are accepted. Oxygen devices are accepted. Extreme obesity is on a case-by-case basis. Be aware that our tables are rated for up to 400 pounds. Beyond that we cannot accept you due to safety concerns. If you are unable to lie down flat on your back for more than five minutes, please consider avoiding our screening. We can work around this by having you sit back in a chair and performing the ultrasound but it is on a case-by-case basis. Call ahead if you have any questions or concerns.
Attire for the screening should be loose fitting clothing so that we can get your belly and legs. We don't require you to disrobe. Avoid wearing a dress as to get your abdomen and we would have to require you to raise your dress up to your bust line. Some people wear undershirts or spandex undershirts. Remember we have to get your bare stomach so consider avoiding these garments. We have you sign in but before you do we require that you read the disclaimer before doing so. Do not sign in or participate in our health fair screenings if you do not agree to our terms.
Pick up a worksheet and read the disclaimer on the worksheet. We encourage you not to sign the worksheet if you do not read it. We also encourage you not to participate in our health fair screening if you do not agree to our disclaimer and waiver.
You can choose a male or a female tech if you prefer.
You can also request a Spanish-speaking tech if needed.
Wait to be called in. At times we can bring you in as soon as you sign an and at other times you may have to wait up to 30 minutes to be seen. We provide water and individually wrapped candies while you wait. There are also bathroom facilities available.
Once you're called in, we bring you into an 8 x 8 privacy tent area with a massage table with a pillow to rest your head. If you prefer to be accompanied by a friend or a family member you can bring them in with you (up to two). We have seats for up to two people and we require you to lay down on the table. If you have children, it's OK to bring them in as long as they do not interfere with the technicians ability to speak to you without having to compete with children if they are not quiet.
We require you to raise your shirt up to your bust line or just so that we can look at the heart. The heart can be identified from underneath the rib cage as we shoot a beam up towards the heart known as the subcostal view. Then we look at your mid belly and lower belly as well as the outside left and right area of the abdomen. We also look at the neck area and legs. If you pay for the additional breast or testicular ultrasound, we use table paper to maintain privacy and modesty.
We have paper towels for you to wipe the ultrasound gel off with and disinfecting hand gel and wipes.
The ultrasound gel that we use is sterile & hypoallergenic. It dries with a slight white residue but will not stain.
Once we complete the screening we annotate notes onto the worksheet and then explain everything we found. At that time we answer any questions and have a short discussion on what your doctor may consider for you.
Your worksheet gets scanned for our own protection in case someone attempts to alter their worksheet, so we would be able to present the original scanned worksheet as a way to protect against tampering.
We also offer a callback worksheet that you can put your e-mail address or phone number so that we can let you know when we're going to be in the area again offering the screening. And that's it. You then take your screen sheets to your doctor and hopefully they use the information we provide for you to increase the quality of healthcare you deserve!
We have paper towels for you to dry off with an disinfecting hand gel and wipes.
The ultrasound gel that we use his head while energetic and sterile but can dry with a slight white residue but will not stay.
Once we completed the screening we annotate notes onto the worksheet and then explain everything we found. At that time we answer any questions and have a short discussion on what your doctor may consider for you.
You then go outside to get your worksheets scanned for our own protection in case someone attempts to alter their worksheet we would be able to present the original scanned worksheet as a way to protect against tampering.
We also offer a callback worksheet that you can put your e-mail address or phone number so that we can let you know when we're going to be in the area again offering the screening. And that it. You then take your screen sheets to your doctor and hopefully they use the information we provide for you to increase the quality of healthcare you deserve!
The thyroid is a single gland found in the neck. It is easily visible with ultrasound and literally takes seconds to identify abnormalities. The most common things we identify are nodules, cysts, goiters, large or small thyroid tissue, and the texture of the thyroid indicating potential disease.
The thyroid can affect:
Metabolism & emery levels
Heart rate and strength
Decreases calcium release from bone
Skin, Hair, & Nail conditions
Graves disease autoimmune disorder
Hashimoto's thyroiditis autoimmune disease
If we find something on the thyroid, we indicate it on the worksheet and you can present this information to your doctor. Your doctor may order blood work to try and determine whether or not the thyroid is producing enough thyroid hormone in the blood to be regular. If it's low, they may trial you on a thyroid hormone. This requires several blood tests to try and determine normal levels. Generally family doctors refer you to a specialist known as an ENT or ears, nose, and throat specialist. There the doctor would do a fine needle biopsy to get tissue samples from nodules or masses found. The majority of thyroid issues are manageable and even in the worst-case scenarios are highly treatable.
Carotid neck artery
The carotid arteries flow oxygenated blood to the brain. Without oxygenated blood to the brain you become a victim of a stroke. As you age and your immune system weakens especially from smoking, you are at an increased risk of developing plaque or narrowing of the arteries. Decreased blood flow to the brain causes a stroke. Carotid arteries are easily visualized with ultrasound and can be evaluated in seconds to determine any diseases present in the arteries.
With ultrasound we actually look inside the arteries and measure the amount of actual blockage, if present. We'll look at blood flow through the arteries to determine if there is any narrowing causing elevated blood flow velocities through the narrow point known as a stenosis. Carotid disease can be present with several symptoms such as dizziness, visual disturbances, fainting, stroke, stroke like symptoms such as paralysis, facial distortion, blindness, weakness on one side and other symptoms.
Often, we are met with patients that have no symptoms whatsoever and in one case we found a patient to be 100% blocked on the left carotid artery and 75% blocked on the right carotid artery to the surprise of the doctor and the patient. A doctor can try and determine problems in carotid artery by listening to the arteries with a stethoscope, but it is not always accurate. Ultrasound is extremely accurate in determining disease.
We document the percentage of blockage for your doctor to consider ordering their own ultrasound so that they can move forward in the evaluation and possible treatment of this disease. We document plaque as small as 5% occlusion, even though clinically not significant, it is significant as not everyone forms plaque. Many doctors may dismiss anything under 20% and never revisit evaluating whether or not you develop more plaque. They follow guidelines set by Medicare recommendations. We feel this is unfortunate because we see people that have commented that they were less than 20% blocked in the arteries therefore the doctor dismissed any further evaluation over the years. In some cases it was too late.
Narrowing or blocked arteries can also be more problematic is you have decreased blood flow to the brain and your heart for whatever reason decreases in output due to dehydration, decreased ejection fraction, or anything that would decrease the outflow of blood from the heart. This would put you at an increased risk of stroke. There is no medication or therapy that can reverse plaque in the artery, only surgery to cut plaque out.
We look at the heart and are able to look at the size of the heart to determine if it's enlarged or dilated, or if it's compressed by fluid. A dilated heart can also be due to COPD your chronic asthma. Pulmonary hypertension can also cause right heart dilation. This is due to the restrictions of the lungs squeezing the vessels that flow through the lungs causing a backup of blood into the right heart causing dilation.
We look at the function of the heart as it beats to see if the heart contracts normally. Abnormal contractions or areas of the heart that do not contract, might be due to heart ischemia or that part of a heart not receiving adequate blood flow through the coronary arteries. This may suggest to a cardiologist that you have coronary arteries that are narrowed or blocked. An abnormal rhythm of the heart my suggests abnormal polarization and the polarization signals causing a heart to be in an arrhythmia in some cases requiring a pacemaker.
We explain to patient's that a pacemaker is like having a new distributor for your vehicle. Before that, your engines wires were crossed and you are running on four cylinders instead of eight cylinders. Once they put in a new distributor all cylinders are firing normally and you have power to your engine that you haven't known about for years.
The heart has four valves that we look at. The valves can leak, known as a murmur, which can be heard with a stethoscope but a stethoscope cannot find all heart murmurs where ultrasound ultimately can. We also look at the valves for their health. The valves can have calcifications or hardness or even vegetation growths. The valves can develop stenosis not allowing blood to adequately flow through the valve. This can cause extreme shortness of breath.
We look at the wall thicknesses of the heart. A thickened heart might be due to high blood pressure or due to a highly athletic individual known as left ventricular hypertrophy. We also look for any holes in the heart that allow blood to flow through the walls of the heart from the high side of pressure to the low side of pressure causing fatigue and shortness of breath. People can live all their lives without ever knowing.
We also look for aneurysms of the heart similar to what you find in the abdominal aorta. The heart has the main artery that is the aorta that can develop an aneurysm. This is what John Ritter died from.
We also look at ejection fraction. The ejection fraction is the percentage of the contraction of the heart that determines to a doctor the adequacy and health of the heart. Normal ejection fraction should be between 50 and 75%. Too low may mean you suffered a heart attack and too high may mean you need to get off caffeine.
The abdominal aorta is the main artery that flows blood out of the heart to the rest of the body. As you age and added risk factors such as smoking are involved, the potential for an aneurysm is increased. The abdominal aorta normally measures 2 cm in diameter. Guidelines state 3 cm aorta is still considered normal but anything above that considered an aneurysm. You can still have an aneurysm if say your aorta measures 1 cm in diameter and you have a 3 cm artery bulb. We would call it an aneurysm but that's up to the doctor to determine. At 5.5 cm or greater a physician will counsel you about undergoing surgery. Abdominal aortic aneurysm surgery is quite perfected these days and is practically an outpatient procedure. In the case of a rupture previous to that however the likelihood of death is very high. There are no symptoms other than perhaps feeling a large heart pulsation in your stomach area. We also look at the iliac arteries that flow blood to the legs. There is also potential for aneurysms in these areas.
Leg arteries are easy to see with ultrasound. We look at the common femoral artery for evidence of plaque. Often people think they have circulation issues in the legs when it's actually a neurologic problem of the lower back and pressing nerves that run down the legs. We find people with long-term diabetes and heavy smokers are the highest patients for risk of leg problems known as peripheral vascular disease or peripheral artery disease. You can quickly identify the circulation by the color of your feet. Another sign is ulcerative leg soars that are not healing well. Another sign is not being able to walk a flight of stairs without having severe cramping in the legs. So we look for any blockages inside of the arteries of the legs and also look for narrowing of the arteries causing decreased blood flow.
The pancreas is located in the upper mid abdomen area. It has several functions but the primary one is to secrete a hormone called insulin. We look for irregularities in the pancreas like masses, cysts, nodules, inflammation, enlargement & texture. Patrick Swayze suffered pancreatic cancer and can be difficult to cure. Symptoms of pancreatic problems can be very painful.
The liver is located in the mid upper abdomen to the very right upper abdomen underneath the rib cage. We look at the liver for its texture to determine whether or not the liver is fibrotic or cirrhosis is present. We also look for liver masses, cysts, nodules or fatty deposits. Liver cysts are very common and usually not an issue. They can try and remove cysts but too often they come back so most doctors don't bother with them other than monitor them. We may find fatty tumors called lipomas as well, somewhat common, but usually not a problem. Surgeons tend to needle biopsy lipomas just to make sure. We also measure the liver to make sure it's not enlarged. More often an enlarged liver is due to fatty deposits in the liver or cholesterol. The majority of body fat and cholesterol come from the liver. This is why cholesterol drugs affect the livers production of cholesterol but at the same time can cause the liver to produce enzymes found in the blood.
The fuel source for body fat and cholesterol is glucose and the switch that turns on the livers production is insulin. We often wonder why doctors don't tell their patients to cut out sugar carbohydrates to lower their cholesterol. Instead they give them a pill. I like to use the analogy of the cow. The cow has three chambers in its stomach and extracts sugar from almost anything but in this case grass. The cow is a very metabolically fat animal. If you raise the cow's sugar levels by grain feeding them wheat, oats, barley, rice, corn or any other grain, it breaks down into glucose than causing the cow to become heavier. Another way to do this is to inject them with steroids. Steroids raise blood sugars causing the cow to get heavier. It was a very inexpensive way to increase weight but many consumers did not want to buy the beef was injected with hormones. This is why cortisol, the steroid our body produces from stress causes us to get fat. So don't stress! Stay healthy.
The gallbladder is located in the upper right abdomen area underneath the rib cage underneath the liver. The gallbladder secretes an alkaline substance known as bile and enters into the very acidic environments to help neutralize acid in the intestinal tract. The gallbladder can become blocked which prevents bile from entering the intestines and causing what is known as the gallbladder attack which is extremely painful. Minor symptoms of gallbladder problems may include excessive acid, indigestion, bloating or gassiness. We look inside the gallbladder to see if there's any evidence of stones. Stones can range from one small stone to the entire gallbladder filled with stones. The problem with stones is that if they are tiny enough they can block the exit of bile through it to called the common bile duct. We also look at the common bile ducted to try and determine if there's any dilation from a stone. We look at the gallbladder wall for inflammation or thickness of the wall. We also try to see if there are any polyps in the gallbladder. There's also a mud like substance called sludge that could be a problem.
Kidneys a relatively easy to identify with ultrasound. We look for stones, masses, cysts, nodules, dilation, shrinkage, texture of the kidney, whether or not the kidney is backing up and we can also see the adrenal glands. We also look to see if you have both kidneys. We look to make sure that the kidneys are of equal size. If the kidneys are not in equal size it may mean that one or the other kidney are diseased. Sometimes you're born with only one and we have reported to patients that they only have one. They since have literally stated I've lived 50 plus years of my life and no one's ever told me that I only have one kidney after all the tests I've done throughout the years.
Ultrasound of the bladder is very easy. We look for masses, wall thickness, helping to determine inflammation or infection. We look for nodules or cysts. We look for dilation of the bladder. Sometimes an excessive volume in the bladder may determine urination issues. At times patients are not aware that they have a bladder of the size of a 2 L bottle. Obviously this is information that they need to speak to a urologist about. Often times we look at the bladder and the volume is not very much yet the patient expresses that they have an urgency to urinate. This can also be reported to a urologist as we would indicate the volume of fluid in the bladder. The bladder is next to the uterus in women and the prostate in men. We also look at those areas to see if the uterus or the prostate are causing decreased volumes in the bladder increasing urination frequency or blockage.
The uterus is easily seen on top of and through the bladder. There's no need to undress or expose yourself. All we have you do is push your waist band down so that we can get on top of the bladder. We look for any fibroids, masses, cysts, nodules. We look for endometriosis. We look for the size and shape and tissue texture of the uterus. We look for pregnancy. If possible we will identify the ovaries. As you age the ovaries become more difficult to identify. If they are identified at an older age, its may be likely due to a developed pathology of the ovaries such as a mass, cysts or nodule.
The prostate is easily seen through and on top of the bladder wall. We do not require you to undress to see the prostate. We look at the prostate for size and shape. Inside the prostate we look for masses, nodules, cysts and stones. The prostate should measure less than 4 cm in diameter. Many doctors use what is known as a digital rectal exam to try and feel the prostate for size and irregularities. It has been our experience however that the majority of irregularities are not on the bottom side of the prostate where the doctor is able to feel but rather on the top of the prostate next to the bladder. That is where most of the problems are identified in the form of masses or abnormal morphology.
The spleen is located on the left lateral upper rib cage. The spleen is responsible for removing old red blood cells and creation of white cells which is part of our immune system. We look at the size and shape of the spleen and the texture. We look for any masses, cysts, nodules, calcifications.
Breast ultrasound is performed using a towel or paper sheet placed over the breast region while either raising both your shirt and bra above your breasts or unfastening your bra and raising your shirt above your breasts or removing your bra completely and raising your shirt above your breasts while covered. Usually we start with the left breast in a clock formation. At the top of the breast is 12 o'clock in the bottom of the breast is six o'clock. So we look at 12, 3, 6, 9 o'clock and then we move to the nipple area. Depending on the breast size, we apply gel to a flat probe, raise the cover up slightly so we can position the probe on the breast, cover you back up, paint the gel on the area of the breast, then proceed to ultrasound in a clock view of the breast. We look for fibrous tissue, which is very common in many breast tissue and not really considered abnormal. We look for masses, cysts, nodules or any dilated breast ducts. Breast ultrasound takes careful skill to attempt an accurate observation of any abnormalities. This is why we request an additional $10 for this scan because it takes more time to perform. Often women state that they prefer to come to us for the breast exam which we discourage. We encourage women to please stay with their appointments for mammograms because they are important and we are offering ultrasound in a screening environment. Ultrasound Screening $70 for 12 studies! Over 16 years experience. Call today (928) 846-5316. What we offer is the potential for additional information that can be presented to their physician to aid in preventative care.
Testicular ultrasound is something many guys don't get access to. For this test we hold up a paper sheet as a many privacy curtain while you push your pants and underwear down to the top of your knees during which time you are covered with the same paper sheet. Next we ask that you grasp your penis with your left and so that your testicles are suspended while staying covered the entire time. We use a flat probe with a small amount of gel and we begin on the left side. We look for any fluid in the testicular sac. Fluid can be a sign of infection of the testicular sac. Some men present with the baseball or softball size scrotum. Generally they give you antibiotics for this but sometimes requires a small surgical procedure to remove the fluid. We look at the size which might indicate a decrease in testosterone. We look at the shape of the testicle and tissue texture which might indicate a diseased testicle or possible cancer. We look for any masses, cysts, nodules. Cysts are very common in the testicles and can cause repeated dull ache's. We look at the veins of the testicle for varicose veins. We look for a sperm duct dilation.
Masses can be found anywhere in the body and with ultrasound can be identified as a more solid lesion. Generally masses identified with ultrasound exhibit acoustic behaviors that present themselves on screen as a very bright density with a very dark center and shadow, comet like tail. The reason for this is that ultrasound cannot easily penetrate a solid mass and will not produce an image beyond the outside structure. For a mass to be to determined as a cancer, requires a needle biopsy or tissue sample be sent to a pathologist. However, ultrasound images can suggest a high likelihood of cancer.
Nodules can be found anywhere in or on the body. Nodules are generally not very dense in tissue structure and provide an easily identifiable spherical lesion identified through ultrasound as less dense than the surrounding tissue. The appearance of nodules with ultrasound is usually slightly darker but easily seen tissue surrounded by a brighter area of normal tissue. The reason for this is that the nodule is more fluid like and less dense than the surrounding tissue, denser tissue produces a brighter images the point where it is so dense that it doesn't produce any image. In the case of a nodule, the tissue is easily identified but not as dense therefore not producing a very bright image. I liken nodules to that of a mole on the arm. It's somewhat jelly like and gummy but not solid. In very rare cases nodules can turn to a cancer but often is not the case. This is why doctors review nodules and monitor them over the years much like a skin doctor would look at a mole each time you go in for a checkup. The reason for nodules are unknown but the prevalence of them increase with age, no different than moles on the skin.
Cysts are fluid pockets encapsulated within a tissue area. Cysts develop anywhere on the body and on the skin for unknown reasons. The most common cysts known are ovary cysts or breast cysts. They're also very common on the thyroid, liver and kidneys. Cysts can also develop on the skin which many people seem to be able to remove themselves much like a very stubborn pimple. Doctors generally do nothing for cysts unless they cause pain. At that point they can either attempt to drain it with a needle or cut it out. However they tend to come back over several months. So, in order to avoid infection, doctors prefer not to treat them. They are easily identified in ultrasound as they appear as a black round sphere without shadowing as a solid mass would appear. Cysts have "never" been known to develop into any type of cancer.
The Medicare privacy act known as HIPAA
(Health Insurance Portability and Accountability Act of 1996)
In short, we are not required to follow the guidelines. The reason for this is that we do not receive any money from the federal or state government for services. Therefore they cannot dictate what we do in this instance. That is why we do not accept HSA monies or credit cards.
This does not mean however we do not care about privacy. We certainly want to make your experience a comfortable one and consider your privacy paramount. The worksheets that you receive from us are not reported to anyone. You keep your copy and do whatever you want with it to include showing your doctor.
If you have any other questions we hope that you e-mail us or call us. Our company wishes to support you in helping to avoid disease and stay healthy. We look forward to seeing you and working with you and hopefully making a difference in your life.
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