Ultrasound Tech’s authority on changing Dr’s order
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My 16 year old daughter has been dealing with ovarian cysts for the last few years. Two months ago the pain was so unbearable she ended up in the Er. They weren’t able to preform an ultrasound for over a week to confirm if it was cysts causing her pain & the ultrasound showed no abnormalities. Two days ago we end up in the Er again, same pain, middle of the night, even saw the same Dr. He gave her an ultrasound order for a transvaginal ultrasound. I explained to her what she could expect & opted not to go back with her to respect her privacy. She returns a short time later & tells me the Tech asked if she had ever had a pelvic exam & since she had not the Tech said she wasn’t going to do the ultrasound the Dr ordered but instead a regular abdominal ultrasound even though my daughter told her she had that same test a short time ago. Are Techs permitted to change the test w/o consulting with the Dr?
0 likes, 3 replies
sanya11314 sarah24505
Posted
Dear Sarah,
I don't know if they can 'change' the ultrasound technique,
but if transvaginal or transabdominal,
the same organs (in this case uterus and ovaries) can be scanned.
So it is the same test.
It seems an ultrasound was issued for ovaries and uterus, the usual, basic ultrasound, which can be done both ways: transvaginal or transabdominal.
Transvaginal is easier for tech and empty bladder makes it also somewhat easier for patient.
For transabdominal ultrasound, one needs a full bladder.
(which has always been the biggest issue for my daughter, is it fills fast and hurts to be pressed on).
They scan these female organs via bladder then.
I don't think the tech has altered the organs that were requested to be looked at, only the ultrasound pathway.
Yes, it will be the same over and over technique for same question especially if ovaries are in the focus.
I once took my girl off the scanning table as she started crying in bladder pain and said, to have her emptying 100ml as my daughter can very well control and interrupt her urine stream as it should not be that painful, just uncomfortable. Eyerolling tech left the room, coming back 30min later, when the bladder was again...totally full. Thanks tech.
I have the same issue: my girl is very shy and not open minded, to have a stick inserted into vagina for an ultrasound. So a transvaginal ultrasound is a violation of her privacy for sure and more trauma than any scope she ever had.
Yet, yes, via abdomen with full bladder is just the same as transvaginal.
You could also have a
plain pelvic MRI for ovaries. But usually considered 'too expensive' to use.
My girl has a lot of pain where the ovaries and appendix (was) are,
but her issue is not that at all and a normal usual basic transabdominal ultrasound of ovaries and uterus would never show that.
My girl has had normal cysts, the ones, that come and go, they are functional, normal, usually not painful, up to 3cm, sometimes left sometimes right, now put to sleep with bc pill. The appendix surgeon was so happy to see a functional hemorrhagic cyst on the right ovary, if only he contacted me: it wasn't there when pain started, so it was not the issue.
cysts have never been the issue for my daughter's very same localised continuous right side pain.
We have now pelvic congestion and nutcracker and MALS/Dunbar on our plate and very hard to ever get that treated.
Also search for very small, not gut involved hernias, like Spigelian hernia.
Rare doesn't mean it didn't exist.
Just to give you a head start:
ovaries and uterus are not always the culprit in female pain. So once cyst size and rupture could be excluded as pain source, it actually get's more difficult.
If you thought of pelvic congestion,
only a VASCULAR ultrasound (also transabdominal) or MRV, CTA can show that.
No basic usual transvaginal or transabdominal ultrasound that you get now for ovary check, will detect that ever.
That's the problem.
You get normal after normal result, because it is not looked at at the very same area.
I hope for you that it's 'just' a functional cyst,
that ruptures on it's own and pain passes.
That would be the easiest explanation and fix for the pain.
But anything else like endometriosis, endometrioma, cyst torsion, pelvic congestion, hernias, appendicitis....won't go away and often need different imaging.
My girl is on continuous bc pill btw after the surgeon so happily accused the functional cyst as a culprit for pain, we have crossed off cysts for good as the easy out explanation of pain (they are gone, and new ones not forming, seen in multiple images, but pain just the same) and her mens pain on top was very strong.
So we are happy with about 4 months of continuous Levlen pill until spot bleeding, allowing 4 days off and back on to avoid any bigger cyst than a tiny pearl.
Once the other horrible pain is managed, we will start being 'female' with functional cysts again.
Bc pill is just an option for us now, to stay without larger cysts or new cysts, also to not distract from real problem.
All the best!
sarah24505 sanya11314
Posted
Thanks for your insightful response. Having a full bladder definitely makes it more uncomfortable for them. I feel horrible having her fill her bladder & have to sit in the waiting room, for what feels like an eternity, just to have the Tech pushing around on her. The Dr explained that the internal ultrasound may show more since we’re not even sure she’s developed cysts again, she described the pain as tho she has. She’s been on DepoVera prior to all of this due to painful cycles that would leave her in bed & home from school. She didn’t have any issues with painful cysts developing until her appendix ruptured about 2 years ago. Being on the Depo I didn’t think she could develop cysts since an egg isn’t being released. The surgeon who removed her appendix told me it was possible from having the infection in her abdomen for so long (she also had a JP Pratt Drain afterward to remove infectious pockets in her abdomen) & another Dr said that’s not possible!! Another Dr told me she’s just constipated. A CAT scan disproved that but I think they sometimes just try to shut me up if they don’t have an answer.
The pain reappears about every 2 months. Same location, lower left abdomen, excruciating pain & doesn’t last more than 8-10 hours so I’m not convinced they’re cysts especially since the ultrasound she had about 2 months ago didn’t show any & the CAT scan was about a week after that. Otherwise, I would think she had one that had ruptured & was causing the pain.
I’m glad you’re girl is doing better. Thanks again.
sanya11314 sarah24505
Posted
It's good to check, but once crossed off the list for pain, other paths need to be looked at.
I was told by prescribing gyn, that not all pills do avoid the formation of new bigger cysts.
Our Levlen pill does. (no effect on existing cysts, but once they were gone, no new functional ones could form) Not sure about the Depo, but I think it is not a functional cyst avoider, even it doesn't make sense, does it.
Pain for few hours and on one side can be 'just' constipation, but also can be abdominal migraine, if accompanied by fever there is the familial mediterranean fever possibility, or an abdominal angioedema (CHE blood level, easy test), but should be seen in imaging.
My girl unfortunately is not doing better at all, she can't walk anymore and is in constant pain, nausea, vomiting, frequent migraines and can only do school on hourly basis, as her vascular issues plus squeezed duodenum are not that easily treatable and first is battled by all docs to even exist. Had to go overseas for diagnosis.
USA is much better for these rare diseases and I don't have a few 100.000USD left over to 'just' fly there to get more testing and one or two complicated surgeries.
So we hang in there and trying the next pain medication as we have to taper off opioids.
It's living hell when it is continuous life disabling pain and docs just being dismissive due to being a teenaged girl. The worst combo. What we had to go to expensive psychotherapies or physio...would fill books.
I just can say: trust your instinct, trust your girl. See how much is bearable and what becomes unbearable. Before my girl was constant pain, it was an intermittent 3 day episode, always triggered with intraabdominal pressure (oboe, sport, carrying school bag) and after eating. Really hard conditions those MALS, SMAS, nutcracker, or loin pain hematuria syndromes.
Just keep them in mind in case the symptoms persist and get more and longer. There is a theory for example, if one time a ureter had an insult (tiny stone, cramping), it can get out of hand in cramping.
I hope you are in contrary to us in USA, then there is some hope in case it get's really complicated and rare.
But I also hope, that the 2 months breaks get longer and all it needed was maybe another bc pill or good stool softener? (we have to take mg citrate 'Calm' everyday, to keep soft, but has no impact on pain as it is a different nature)
All all the best!
Let's see what your ultrasound will reveal! It's very hard when they are in so much pain.
and really sad, her appendix ruptured. If she had adhesions from back then formed, it would be more frequent pain, wouldn't it?