Nice Work If You Can Get It

To Commemorate NY's Silver Debacle, I've played with the lyrics to a Dire Straits Classic.

$$$ Por NADA

Look at them yo yo's - that's the way you do it
Legislators in the L.O.B.
That ain't working - that's the way you do it
Money for nothing and your trips for free.
Now that ain't working that's the way you do it
Lemme tell ya those pols ain't dumb
Maybe holding more fundraisers
Maybe give taxpayers a crumb

We gotta drain the stinking swamp
Democracy Recovery
We must remove the legislators
We owe it to our progeny

I shoulda learned to get donations
I shoulda learned to raise the funds
Look at that charmer muggin for the camera
Man we coulda had some fun
Look he's up there, makin campaign noises
Kissing babies for them all to see
That ain't working, that's the way you do it
Money for nothin and your trips for free

We gotta drain the stinking swamp
Democracy Recovery
We must remove the legislators
We owe it to our progeny

Now that ain't working, that's the way you do it
Money for nothin get your trips for free
Money for nothin and your trips for free

Term Limits Anyone?

Transvaginal Ultrasound - The Rest of the Story

Recently, an incredibly useful diagnostic tool for women's health has become embroiled in the firestorm of abortion politics. I'm speaking of transvaginal ultrasound and I'm here to try to set the record straight. Transvaginal sonography, or TVS, has been around for longer than you think, having come a long way from the first use by the Japanese in 1971. The technique was popularized in the late 1980's as a logical extention of women's healthcare. Rather than have a woman fill her bladder to point of significantt pain and disttress, a small, high frequency transducer is simply placed close to the organs of interest, resulting in images usually far more detailed than those obtained from the transabdominal route.

During this introductory phase of TVS, I was a practicing gynecologist and it seemed a natural extension of my pelvic examination. I was initially using a small standard pediatric transducer which was easily introduced, but switched over to the standard long-handled probe when I got the chance. As a shameless plug, I'd like to say I was, at least in my neck of the woods, a pioneer in this regard. I found quickly that I could evaluate potential difficulties in early pregnancy for those women who thought they were miscarrying and usually reassuring them that things were OK. I could also confirm the location of an early pregnancy, often a week earlier than transabdominally. This came in handy in those cases of suspected tubal pregnancy, which previously wasn't diagnosed until the woman presented to the emergency room in significant distress.

TVS also was able to characterize ovarian cysts, with endometriomas and dermoids usually exhibiting such a distinctive appearance that a definitive diagnosis became possible. Now, when coupled with sensitive color and power doppler, vascular signatures can be determined, facilitating the diagnosis of ovarian cancer, often at an earlier stage than before.

Today, TVS has many uses in both obstetrics and gynecology. Monitoring cervical length in patients at risk for preterm delivery is routine. TVS is often useful in evaluating fetuses for certain abnormalities such as anencephaly. In women undergoing IVF, monitoring of follicles and obtaining eggs via the transvaginal route is standard of care. TVS, especially with 3D probes, facilitates the monitoring of the location of possibly malpositioned IUD's. Three dimensional multiplanar transvaginal sonography produces images of the uterus which can rival an MRI, allowing cost-effective diagnosis of uterine malformations and location of fibroids and polyps. Instillation of saline into the uterus in patients with abnormal bleeding is now a standard technique for triaging therapy for these women.

So, once the political smoke is allowed to clear, we're left with one impression. Transvaginal ultrasound is an impressive advance in women's healthcare. It's truly frustrating that this diagnostic modality has become such a political football. I truly hope that the dust settles sooner rather than later.

If you have any questions, feel free to leave a comment or tweet me @sonodoc99 on Twitter.