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Thanks for the info Chris, I think the same protocol could be used here in Vermont as well.

 Matt


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Willis, Chris
Sent: Tuesday, January 12, 2010 12:15
To: [log in to unmask]
Subject: Re: cold immersion studiies

Any patient that comes into our lab with suspected Raynauds will get a full pvr/segmental exam.  We obtain ppg waveforms on all 10 digits with a gain setting of 45 (Parks electronics pvr machine).  We derived this gain setting by using one of our techs as a "norm".  After obtaining the ppg waveforms they are evaluated.  If the waveforms are decreased in size, appear damped or even flat line we warm the digits for approximately 10 minutes in warm water.  We repeat the same process with the same gain setting and the majority of these patient's waveforms will double in size if not triple in size.  These patients are given a diagnosis of vasospastic disorder ( Raynauds).  If the waveforms do not increase in size the are given a diagnosis of possible fixed obstruction.
 
We get Raynaud's patients more in the fall and in the winter in Maine.  These patients have ongoing if not continuous symptoms because it is a constant cold climate they are exposing their hands to as opposed to warmer more southern states where it is warm year round until they expose their hands in a cold environment (freezer, grocery store cooler).  Most of our patients are symptomatic at the time of the exam.
 
I am not in any way saying cold immersion is wrong, we just prefer to do the warm immersion instead.
I need to emphasize that abnormal baseline ppg waveforms should not in any way give a diagnosis of a fixed obstruction.
 
 
 
Chris Willis RVT
Coordinator
Vascular Laboratory
Eastern Maine Medical Center
Bangor, Maine 04401
Phone:  (207) 973-7471
Fax:  (207) 973-7450

________________________________

From: UVM Flownet on behalf of Smith, Matthew G.
Sent: Tue 1/12/2010 11:41 AM
To: [log in to unmask]
Subject: Re: cold immersion studiies



Chris,
Warm immersion study without cold stress, do tell...what's your protocol and how does your pre-warming interpretation work?

 Matt


-----Original Message-----
From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Willis, Chris
Sent: Tuesday, January 12, 2010 11:16
To: [log in to unmask]
Subject: Re: cold immersion studiies

I have posted this in the past on the Flownet but we do not perform cold immersion we only perform warm immersion.
Yes, the waveforms are abnormal pre warming.  If the waveforms are abnormal post warming the patient is diagnosed with a fixed obstruction.  If the waveforms increased post warming, they  are diagnosed with a  vasospastic condition.
Almost all of our confirmed Raynauds patients have abnormal waveforms pre warming.

Chris Willis RVT
Coordinator
Vascular Laboratory
Eastern Maine Medical Center
Bangor, Maine 04401
Phone:  (207) 973-7471
Fax:  (207) 973-7450

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