Making Scents of Sonography

One of sonographer Rita Chew's patients was freaking out. High-risk for thyroid cancer, this patient needed to have a biopsy, which included 12 needles stuck in her neck; six for each nodule. The patient was deathly afraid of needles. In fact, she was sent to Chew's office for the procedure because she had previously run away from a hospital just before a biopsy was to be performed.

"They opened up the tray to do her procedure and she took off," Chew recalls. "When she came to us, she was really nervous. She really wanted to get it done, but didn't want to go through with it in a way."

Since the patient drove herself to this appointment, Chew and the staff could not give her any medication to help calm her. That was when Chew remembered she kept a bottle of lavender oil in her purse for times when her children needed something to help them calm down. Chew asked the patient if she could try something to help her relax. She put a few drops of the lavender oil on a tissue and asked the patient to sniff it for a few minutes while Chew got the biopsy tray ready.

The patient sat on a bench, holding the tissue in her hand and inhaling the lavender oil until her physician was ready to perform the biopsy. As the patient began to feel better, the staff was able to lie her down and prep her neck. With the patient still sniffing the tissue, the staff successfully completed the biopsy. "She didn't flinch, she didn't move a muscle, she wasn't worried or freaking out. We completed the procedure and got everything we needed," says Chew. "And when she sat up at the end of it all, she said, "Oh, I feel so much better. I didn't think it would be as easy as that.'" For a patient with an intense fear of needles, the success of the procedure was a remarkable feat and helped her receive the proper healthcare she needed – and it was all thanks to Chew's quick thinking and her experience with the effectiveness of aromatherapy.                

Forging a Partnership

Once Chew saw the results the lavender had on the nervous biopsy patient, she began brainstorming for ways to incorporate aromatherapy into ultrasound imaging. The problem with having the patient inhale the oil from the tissue was that with the machines putting out heat, the entire room fills up with the strong lavender smell. Chew was concerned that the next patient who came in might not particularly enjoy the smell of lavender.

"So I thought, well, what if we put the lavender in the gel itself because when you use the gel, you wipe it off when you're done. We have a bin that we throw the used towels in, and it shuts like a drawer," Chew says. "So any scent that would be in a gel would go with the towel, and it worked."

Chew shared this idea with her long-time friend, Tina Modrovich, who has worked in aromatherapy for many years. The pair mixed lavender with some transmission gel to test Chew's theory. "When we threw the towel in the bin, there was no lingering smell," Chew says.

Taking the Next Step

There may have been no lingering smell, but there certainly was a lingering idea that piqued the duo's curiosity. Chew and Modrovich began to research the ultrasound gel market and were surprised to find that no aromatherapy ultrasound gel existed. "It's such a simple idea," says Chew. "They've been doing it in massage therapy forever."

They then surveyed a group of people to determine their preferences in the ultrasound experience. About 80 percent chose aromatherapy enhanced gel over the generic.

Once Chew and Modrovich decided to develop the idea, they enrolled themselves in a business course and within a few months, they formed their own company, Essoula, a modified version of "essential oils for the soul." With the help and support of investors, family and friends, Chew and Modrovich were able to get the Everett, Wash.-based company on its feet and develop their product.

Everyday People

With Chew's networking skills and extensive background in sonography and Modrovich's expertise in aromatherapy and  the healing therapies, the two make an incredibly dynamic and qualified team. As co-owners of Essoula LLC, Chew and Modrovich work relentlessly to get their product out all over the world. The two became friends many years ago through a mutual acquaintance and their business relationship has taken their friendship to a new level.

Rita Chew, RDMS, RDCS, RVT, has more than 20 years' experience as a sonographer and has worked with just about every modality under the sun. Tina Modrovich has more than 15 years of experience in the healing arts, especially aromatherapy.

Although Modrovich insists that Chew came up with the idea, Chew says, "[Tina] planted the seed a long time ago. When my children were upset, she would recommend putting lavender oil on a tissue and rubbing it on their crib. And it works really well. And that was what was on my mind the day I had a biopsy patient who wasn't able to tolerate the procedure."

The Right Stuff

Essoula Comfort Ultrasound gel is a specially developed transmission gel enhanced with aromatherapy oils to soothe the patient, as well as the tech. The gel helps patients as the scent of the oils is absorbed into the skin, increasing the patient's levels of seratonin in the brain, inducing relaxation. "You don't have to believe in [aromatherapy] for it to work," says Modrovich. The soothing aroma of Comfort also benefits the techs, who  suffer from the everyday stress of seeing many patients and being understaffed.

Comfort's formula was carefully developed so that the scent would not be too strong. It was also developed to be completely safe for adults, children and especially pregnant women. The seven essential oils used come from different plants, such as ylang-ylang, geranium, elemi, patchouli and rose, but there is no recognizable fragrance, nor is there an overpowering flowery smell. "Both men and women like the smell," Chew says. Some people might be surprised to learn that there is actually no lavender used in Comfort.

"Tina and I were very much in agreement that we wanted to use the highest quality, 100 percent pure scented oils that we could get, because that is the foundation of the product; and we don't want to cut corners there," says Chew.   

Modrovich says, "Rita did a lot of work on mixing the product and using it in her clinic before we actually had the product manufactured, so she did all the homework."

Getting the Word Out

Thanks to their recent business course, Chew and Modrovich were armed with the knowledge they needed to launch their company and product. Things began to fall into place for them.

"Applying for FDA approval was surprisingly easy," Chew recalls. "The operator even stayed on the phone with me past his working hours to help guide me through the forms." Essoula Comfort gel was granted 510(K) clearance in April 2004 and the product was ready to be introduced to the consumer market, which spends $700 million on ultrasound transmission gels annually.

Starting out in their corner of the Pacific Northwestern United States, Chew and Modrovich made the rounds at local sonography facilities and handed out free samples. Their public relations campaign consists of appearing at tradeshows, advertising in trade publications, visiting medical offices and offering free samples from their Web site (www.essoula.com). Susan Cole, director of sales and marketing for Essoula, calls it a "grassroots" campaign. All three women at one point stored boxes of Comfort gel in their houses. "I would walk into my house and it would smell like Comfort," says Cole.

Invigorating the Ultrasound Experience

Jim Baun is the director, senior consultant and clinical practitioner for Professional Ultrasound Services in San Francisco. He first learned about Essoula Comfort Gel through a former student of his who stumbled upon the company's Web site and was excited to learn about the offer for free samples. Baun was curious about the product and requested samples from Essoula.

"I was thinking I'd get one of those little single-use packets," he says. "But they sent me four full bottles of gel, so I got a chance to really use it."

Baun, who has been involved in the sonography field for decades, found that Essoula's Comfort Gel is different from the blue water ultrasound gel that is standard in sonography.

"The aromatherapy component is very subtle. It's soothing – it's not overpowering. It's not perfumey. The acoustic characteristics of the gel, which I'm concerned about as a sonographer, are perfectly similar and acceptable in terms of sound transmission. It even seems silkier than standard gels."

As for using the aromatherapy ultrasound gel on patients, Baun says it fits in with the patient-focused school of thought that is becoming common practice in the United States, as opposed to the "olden days when [ultrasound] was really more of a medical-based diagnostic test where the sonographer could not talk to the patient about anything."

Baun points out that ultrasound is really the only modality in which the clinician continuously touches the patient throughout the imaging process. "It's a very intimate experience with the patient in terms of physical contact," he says.

In fact, Baun's own philosophy meshes well with Chew and Modrovich's mission of providing the patient with a comfortable ultrasound experience. In addition to using the aromatherapy ultrasound gel, Baun employs other ways to make the patient feel more relaxed in the ultrasound suite, such as art on the walls, classical music and dim lighting. All of these ways are part of the healing process that, according to Baun, allay the  psychological issues, anxieties, concerns and fears that most patients have when they come in for any kind of test. "They're scared," he says.

He also believes in the importance of sitting down with the patients and talking with them for a few minutes before "slapping the gel on them and starting to push on them." Baun notes that other facilities in California have begun to emulate the little details that enhance the patients' ultrasound experience.

"If the sonographer can take 30 minutes to relax the patients just by touching and by using the Essoula Comfort gel, the environment and the ambiance improve. It's amazing how the patients perceive that," Baun says.

It's All "Gelling' Together

Since its creation in March 2004, Essoula LLC has grown into a full-fledged corporation with a board of advisors, investors and administrative staff, which work closely together to guide the company to future success. Currently, Essoula is planning to make Comfort gel available in 5-liter containers, based on customer feedback. The feedback they've been receiving from the marketplace has also led them to design a Comfort Lite formula, which is a lighter viscosity and fragrance. They have also lowered the price of the 250-ml bottle. "The lower price makes Comfort gel available to everyone," Chew says.

Comfort gel is used for many diagnostic procedures, including bonding mother and baby during routine sonograms. Currently, plans are in the works for different blends of essential oils for certain medical purposes. A pediatric blend, sports and cardiovascular blend are in the research and development phase.

Chew and Modrovich are also optimistic about coming out with new products in the future. "The product ideas are coming up pretty much on a daily basis now, and we just put them in a little thing called "the idea box,'" Modrovich says. Once the funding for their initial products, Comfort and Comfort Lite, is complete, they plan to repeat the same procedure as before to get them on the market.

Mission: Very Possible

Five years ago, if someone asked Chew and Modrovich if they would ever invent a product and start a company, they would have probably laughed. Both women attribute their success to "idea meets opportunity." Chew's experience with the biopsy patient gave her the idea to make the ultrasound experience a more positive and comfortable one for both the patient and technician.

"It's not the actual ultrasound procedure itself that stresses patients out," explains Chew. "The anxiety lies in the results. People always seem to have in the back of their mind, "Is it cancer?' In the case of obstetrics, it's "Is my baby okay?'" In Chew's experience, when patients are nervous, they are less likely to comply with the technician's instructions. Comfort gel is the solution she came up with to make each ultrasound more personal and comfortable.

Starting a company was just a way for this sonographer and aromatherapist to have the opportunity to help people. By listening to feedback and running their business wisely, the cofounders of Essoula LLC are finding their experience to be both rewarding and fulfilling.

"It's been a growing process," says Chew. "It's amazing."


— Jane Kollmer is the assistant editor of RT Image. Questions and comments can be directed to jkollmer@rt-image.com.