Here! Here! Terry. Walking the hall would obviously not work for the younger patient however given our typical 70-80 y/o with concomitant heart disease, this is truly THE BEST! for the reasons you describe. It also allows you to observe the gait which will often answer the question. The “neurogenic shuffle” is a fairly obvious sign when you see it.

 

Bill Schroedter

Venice, Fl

 

 

 

Andy,

 

It is real easy to have the patient walk in the hallway at their normal pace till symptom onset.  This way you are not exposing them to any risks they do not normally expose themselves to in daily routine.  I am a big proponent of arterial imaging but would not consider performing a study without including at least resting ABI’s.  Another technique if you are into torture is reactive hyperemia assessment then there is no exercise component but you are still able to fully investigate and delineate the origin of a patient symptoms.

 

Terry J Zwakenberg BS RVT RDCS

 

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of LICC Vascular Lab
Sent: Friday, September 09, 2005 12:51 PM
To: [log in to unmask]
Subject: Re: ABI'S/POST EXERCISE ABI'S

 

Terry and Kathleen:

I agree that a normal PVR/CW/SBP study should include exercise if the complaints warrant, however as an IDTF and with no medical doctor on hand sometimes, I will not perform exercise (toe ups) if the patient has any cardiac risks.  This is where (and why) an arterial duplex is so valuable.  It will localize and quantify disease.  The question remains that if the physiologic study is normal, a duplex is "not medically necessary," "on the same day" per Medicare!

Andy Bebry

----- Original Message -----

From: [log in to unmask]">Kathy Palmieri

To: [log in to unmask]">[log in to unmask]

Sent: Friday, September 09, 2005 10:01 AM

Subject: Re: ABI'S/POST EXERCISE ABI'S

 

Terry, I agree with you. In the labs that I work with, in their arterial algorithm for studies, we include exercise with all normal ABI's. If the patient presents with positive symtoms, such as claudication, atypical leg pain, buttock pain,etc. and they are found to have normal ABI's, they are exercised, either by treadmill, or toe up exercises and almost always have decreased ABI's after minimal exercise. The cardiologists are especially interested in these findings in light of the recent papers suggesting that ABI is an excellent marker for atherosclerosis. Normal ABI's can be a misleading finding; we see it frequently with Diabetics too. K

Kathleen Palmieri, RVT
Senior Consultant
Cardiovascular Technology Resources
Skaneateles, NY 13152
http://www.krpaccreditation.com
phone (315) 685-0631
fax (315) 685-3209 To unsubscribe or search other topics on UVM Flownet link to: http://list.uvm.edu/archives/uvmflownet.html

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