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Dr. Miller: Diagnostic ultrasound. We're going to talk about that next on Scope radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm Dr. Tom Miller and I'm here with Dr. Daniel Cushman. He's a sports medicine physician in the Department of Orthopedics at the Orthopedic Center here at the University of Utah. Daniel, welcome. Tell me a little bit about ultrasound-guided diagnosis of musculoskeletal disorders. I know this is a new technique, relatively new. It's been around for a long time but it's finding more applications these days.

Dr. Cushman: Definitely. Ultrasound is kind of a non-invasive way of looking at structures underneath the skin. It doesn't do a great job for things like bones which we have X-rays for, but if you're talking about something above the bone like a tendon or a muscle or those kinds of things, we can see those very well with ultrasound.

Dr. Miller: Does it assist you in your clinical diagnosis?

Dr. Cushman: All the time. For example, somebody hurts their shoulder, we can get a good look at those tendons, the rotator cuff tendons with ultrasound or if somebody's wrist is hurting we can look at the tendons there. Sometimes we can look at nerves particularly to see if they're being pinched somewhere.

Dr. Miller: It would help you, let's say, looking at a shoulder with an ultrasound, that might help you determine whether there was a full thickness tear or partial tear or even no tear.

Dr. Cushman: Exactly, and that's something that on exam when we're examining patients it's not something that's as obvious as it seems it should be. A lot of the time we can have patients who have completely torn their rotator cuff and they don't really have too many problems and then the opposite is true where somebody has done almost no damage to rotator cuff but they're in severe pain.

Dr. Miller: This would also help you decide on the guidance of treatment, right? Whether they go to physical therapy or whether you rest the shoulder for time.

Dr. Cushman: Exactly.

Dr. Miller: It just gives you a better sense of your diagnosis I suppose.

Dr. Cushman: All the time.

Dr. Miller: The other thing that's interesting is you're doing this right at the clinic visit, so this sort of obviates the need for having an MRI.

Dr. Cushman: Yeah. Definitely. A lot of the time I'll just simply grab the ultrasound machine with my patient in the room and it just takes a little bit of gel and that's pretty much it.

Dr. Miller: So this also maybe has a lower cost than the standard sort of other imaging techniques that we have.

Dr. Cushman: It's significantly lower and I don't know the exact numbers but probably somewhere in the range of a tenth the price of an MRI if you're looking at a shoulder for example.

Dr. Miller: Is it as good as good as an MRI for looking at, let's say again, a shoulder?

Dr. Cushman: Yes. That's really dependent more on the person doing the exam. If somebody has had a lot of experience with ultrasound, studies show they're about as good as an MRI. If somebody is not as experienced, then it's really only as good as the person who's doing the exam.

Dr. Miller: What other areas of the musculoskeletal system do you use this on? How about Achilles tendons or . . .?

Dr. Cushman: A lot of the time we can tell without having to use the ultrasound machine what the problem is but other times it's very helpful and so Achilles tendons, we do use it on occasion. There are there are some times where we think we know the diagnosis and this really either confirms it or shows us that something else is causing the problem and so it's helpful in that regard.

Dr. Miller: How about in the hip?

Dr. Cushman: In the hip joint there's a couple of uses for that pretty commonly. People who have had hip replacements where they can't really do an MRI afterwards and they still have some pain, a lot of times some of the hip replacement surgeons will have us take a look at the tendons that are going over the the prosthesis.

Dr. Miller: Sometimes patients will come in with pain and you've told me previously that you can use the ultrasound to sort of find out where that pain arises from or is there a structure along the nerve that is actually causing the pain. So for instance you might think it's . . . the patient may tell you that they have pain at the wrist or the end of the arm but actually the generation of that pain is higher up and you've learned that from the ultrasound.

Dr. Cushman: Yes, exactly. One of the one of the disadvantages of something like an MRI is you can really only do one segment at a time so you can only look at the neck or you can only look at the shoulder. You can't really do both at the same time. With an ultrasound, if you're thinking maybe a nerve is causing this, you can trace it all the way from the finger, all the way up the arm to the shoulder, to the neck and get a pretty full view of the entire nerve or whatever structure you're really looking for.

Dr. Miller: How many specialists like yourself are versed in using ultrasound as a diagnostic tool nowadays?

Dr. Cushman: Here at the U, there's probably about four or five of us at least in our department and it's getting more and more popular because it's such an easy test for patients. Patients generally love it by comparison to having to do an MRI or going back and additionally it's so much cheaper for the patient.

Dr. Miller: It also gives you real time feedback so that you don't have to wait for test results coming back from radiology.

Dr. Cushman: Definitely. A lot of the time, one other thing I was going to mention was that when patients say, "It hurts when I do this," and they move their arm or they move their leg, we can actually look at it while it's moving as opposed to an MRI or an X-ray, which only shows a static picture.

Dr. Miller: Do you think in the future that more orthopedic surgeons and sports specialists will be trained in this technique so that it's pretty common throughout the specialty?

Dr. Cushman: I think so. I think it's becoming kind of a second set of eyes for people to look under the skin.

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Interviewer: Exploring a medical assistant career, hat's next on The Scope.

Announcer: TheScopeRadio.com focus on careers in health care.

Interviewer: You're considering a career as a medical assistant, but you don't quite know where to start. Well, we're going to help narrow down this down for you, make it a lot easier to understand. Christine Edwards is a medical assistant at University of Utah Health Care and we're going to ask her about how she got to where she is, what kind of education it took, her experience with finding a job, what she's learned about being successful, and advice for those considering a career as a medical assistant.

As far as being able to get into a health care environment, is this kind of an entry-level job? Is this like a foot in the door?

Christine: It can be, yeah. It's a good place to start.

Interviewer: What kind of education did it take to get to where you are as a medical assistant?

Christine: Well, I didn't take the typical path that a certified medical assistant takes. I started out as an EMT, out working in trauma, and in an ambulance, and out in the field.

Interviewer: What kind of training was required for that?

Christine: I did go to Weaver State and so it's very similar to what a medical assistant training is. We did medical terminology, anatomy, physiology. Those things are all really important to know. We did phlebotomy training, EKGs, IV starts, those sorts of things.

Interviewer: So you approached from the perspective of being an EMT?

Christine: Right.

Interviewer: How do other people approach it? There's medical assistant school, right?

Christine: There is.

Interviewer: That would teach a lot of the things you probably mentioned.

Christine: There are some great schools. A lot of community colleges are a great place to start for people. They're a less expensive route. I think Salt Lake Community College has a program, Weaver State, the DATC, I think, has a medical assistant program.

Interviewer: How difficult was it to get into school to become an EMT? Or have you heard anybody talk about how hard it is to get into medical assistant school?

Christine: It wasn't really hard. You need to have good grades. I think if you were going to be in this field, a patient wants somebody who knows their stuff. I would get your general education out of the way because you never know as an MA, you might find something that you're just totally passionate about, something that you're totally interested in, and the university encourages you to get education. You might be interested in radiology, or women's health, or dermatology, or something like that, and that just opens doors for you to take other classes and progress in your career.

Interviewer: So you don't have to have a bachelor's degree in order to become a medical assistant?

Christine: No.

Interviewer: You can go to Salt Lake Community College and get your associate's and be able to then start your career at least and then become more educated, it sounds like.

Christine: Yes, that's a great place to start.

Interviewer: Is there something that if somebody wanted to prepare for this career that they could do before they went to school or while they're going to school that you'd recommend other than the classes and getting good grades?

Christine: You need to have an interest in medicine and I think the human body and an interest in science, I think, and helping people. Having compassion and I guess being able to jump in and change direction at a moment's notice and think on your feet.

Interviewer: Sure. So I've heard that a lot of times, in order to even get accepted to medical school, you have to have some sort of a volunteer history that you've actually worked in the health care environment.

Christine: That's a great way to start because it's a good idea to kind of see if medical type of work is for you. Some people will get into it and they see blood and they pass out. I think a great place to start is to volunteer at a hospital or assisted living, old folks' home, that sort of thing. The best place to listen to lung sounds is in this assisted living place. You'll learn so much. You can listen to heart tones and I've heard friction rub and all kinds of arrhythmias there. So it's a great place to learn.

Interviewer: I know this is going a little outside of your personal experience, but how hard is it to then get a job in the field?

Christine: It's not very hard at all. Right now, I know of several positions that are available at the university hospitals and clinics. There's a lot of variety in the medical field, a lot of different departments that you can go to. I mean, you can get a job in pretty much whatever you're interested in.

Interviewer: And there's a demand for people with these skills.

Christine: Yes, it's hard to find. I mean, even an MA just fresh out of school. It's hard to find us.

Interviewer: For a lot of people, is this kind of the end of the career? They become a medical assistant or for a lot of people, are they looking to move further in health care and do something else?

Christine: For some people, it is. For most of the MAs that I know, I know of three that have gone on to med school and several that have gone on to PA school. Myself, I'm applying to PA school right now.

Interviewer: So there are opportunities to move up and take on more responsibility, whether it'd be going on to PA school or becoming a physician. What about within medical assisting? Are there opportunities to move up there?

Christine: Yes, the U has an MAA position, which is a medical assistant advance and that's usually a medical assistant that has more experience. They'll do things like leadership. They'll plan schedules. They'll attend meetings. They'll train new EMTs as a preceptor. I think there's a lot of opportunity for growth in the MA field.

Interviewer: And you get to work very closely with the physicians so you're actually really learning a lot while you're doing your job as well, it seems.

Christine: Yes, I'm really lucky. I have some amazing doctors that I've worked with over the last seven years as an MA. I've been here at the U for 10 years and it's just progressed that whole time. I've loved m experience here.

Interviewer: Yeah, that's very cool. So do you have advice for somebody who's considering a career as a medical assistant?

Christine: Get the generals out of the way because you're going to want to learn more. Study hard. You really need to like working with people. You'll see them at their worst. You'll see them at your best and you have to be willing to accept that. Sometimes they need you just to listen more than anything, I think, and just let them get whatever it is out.

Interviewer: Ultimately, if you were to party and you were talking to somebody about becoming a medical assistant, how would you cheerlead them on to . . .

Christine: I'll tell them, "Go for it."

Interviewer: . . . and taking the . . .

Christine: It's one of the best careers there is out there." It's really rewarding and not only intellectually but the lives that you touch I think is amazing. I've been called up to the front desk and had a patient bring me cocoa and tell me thanks for brightening their day and they just wanted to brighten mine. I've been really humbled that they would even think of me that way to stop by on their busy day just to say hi and thank me.

Interviewer: How often in our day-to-day . . . for a lot of us, the jobs that we do, are we even thanked at all?

Christine: Not very often.

Interviewer: So just even that nice, small gesture, that sounds fantastic. You're just beaming talking about it.

Christine: It amazed me. I was so humbled that they would even think of me that way. I'll go out in the front lobby and the patients are excited to see me. They'll hug me. It's awesome. It's like extended family.

Interviewer: And you just love it.

Christine: Oh, yeah. It's the best.

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Dr. Miller: Could you have a pelvic fracture? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi, I'm Dr. Tom Miller and I'm here with Dr. David Rothberg. He's an orthopedic surgeon and specializes in trauma care. David, how would one know if they had a pelvic fracture? Now I know that these are fractures that don't just occur spontaneously. Generally, people will have some type of trauma. Tell us a little bit about how that happens. How does one suffer a traumatic pelvic fracture?

Dr. Rothberg: There really are two separate patient populations that will have a pelvic fracture. One is the patient with a devastating life-threatening injury. These are not ones where you're questioning. These are patients that come in as a Level 1 trauma activation, but really a lot of these come in in an older patient population who have had a ground-level fall. They've tripped on the carpet, or over a dog, or something like this, and they can have pain anywhere from there groin, their abdomen, or low back, and that's when the work-up starts.

Dr. Miller: Is it sometimes confused with a hip fracture?

Dr. Rothberg: Commonly. The type of pain that you have with those two fractures is extremely similar, and we typically will figure out which one it is by taking x-rays.

Dr. Rothberg: Now a pelvic fracture, I guess depending on the type of patient, generally those are surgically repaired. They're fixed and treated, and then there's a recovery period. What about a pelvic fracture? How do you treat those? It seems like it would be kind of hard to cast a pelvic fracture.

Dr. Rothberg: Yeah, that's true.

Dr. Miller: It's like a rib. You can't cast ribs.

Dr. Rothberg: We don't cast pelvic fractures. What we're trying to figure out when we're working up some of the pelvic fractures is is the pelvis stable or unstable? And what that means is how much motion is in the pelvis when someone would walk.

Dr. Miller: And how do you determine that?

Dr. Rothberg: It's based on physical exam, the x-rays, and oftentimes a CT scan really looking at the pattern of the fracture, or how the bones are broken, and trying to determine the best course.

Dr. Miller: So in a pelvic fracture, would you operate on them from time to time?

Dr. Rothberg: Yeah, it's a very common operation for us. We do them almost daily, if not weekly. It really depends on the age and patient health status and mobility, and a lot to do with what they've broken.

Dr. Miller: Is the recovery time similar to a repaired hip fracture, or is it longer? Is there a difference in the type of recovery?

Dr. Rothberg: It's pretty much in the same ball park depending on the pattern of fracture they had. The surgery is a little easier to recover from. The surgery is not as invasive, but the ability to get back walking is about the same. It's tough in the early period, but we do expect that most people will get back to their daily life.

Dr. Miller: So the real key is if someone falls at home, especially an older person, and they have persistent pain they ought to be checked out and receive some type of radiologic study in order to determine at least initially if there's a fracture.

Dr. Rothberg: That's exactly right.

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