I'll preface this by reminding you of the respect I have for you, BUT... If you are rarely standing patients to elicit reflux, I would maintain you are not identifying it all.  I suppose "rarely" is a subjective term however, in my experience in Phlebology ultrasound, even if there is obvious supine/modest tberg reflux, there is covert additional pathology not recognized until standing.. either an direct or indirect perforator, accessory tributary, giacomini vein etc etc


Doug Marcum
*Advanced Ultrasound Consultants
*Global Vein Solutions
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On Feb 9, 2011, at 10:06 AM, "Smith, Matthew G." <[log in to unmask]> wrote:

> Nancy,
> I admit it, I rarely have to stand patients to elicit reflux and also believe ICAVL should alter the wording in the patient positioning section of venous reflux studies.  To me it's like requiring us to scan arterial studies while the patient is running/walking in place since that's when the symptoms are worse.  I wish I could love my multi-thousand dollar table but I'd just rather just scan in a normal fashion to be honest.
> Matt
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy Williams
> Sent: Tuesday, February 08, 2011 21:05
> To: [log in to unmask]
> Subject: Re: Venous Reflux and ICAVL requirements
> And again....soooooo, not condemning the use of the $7000.00 table here.
> Kudos. 
> So do not work for Dr. Mengele. I have a very nice table in a very nice
> office with very nice doctors who don't make me lay in the floor.
> So delighted that everyone but me seems to have 3 hours to do these vein
> exams and arrange your accoutrements. 
> But please, isn't there anyone, just anyone, out there brave enough to
> admit they aren't using this wonder table or some other such
> contraption? Someone to admit that they just stand their patients at the
> side of the bed or use a nice reverse trendelenberg? Someone who has not
> been put into an iron lung by career ending injuries? Someone that
> manages to go to work and not break their backs or kill their patients
> in the process that is willing to share some tips and quite possibly
> save a life???? If not I'm pretty sure this horse is dead...God knows I
> hope it is...Cuz it needs to be!...Peace!
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