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hi Bill,
I am sorry if my post sounded as though I only cared about family, friends, etc.  I only meant to point out that if it were a family member or friend of the person questioning procotcol in order to shorten time, that person would not want short cuts made.
As for my money's worth...I would want my insurance company to pay for an incomplete exam.  To me this is fraud.
I hope that makes more sense.

Connie

----- Original Message -----
From: Bill Johnson <[log in to unmask]>
To: [log in to unmask]
Sent: Sun, 28 Oct 2012 14:16:55 -0400 (EDT)
Subject: Re: Entire leg vs to knee venous

Bill from the Great Northwest

Connie,

I think you know me, at least online.  It is always about "best care" and
that is not always about "money's worth", and to my limited mind, we should
give our "best care" to everyone that crosses our door.  Family, yes we
should care more, friends as well but we should care just as much about
anyone given to our care.  I love your post, Connie, and I also love your
attitude.  But "just may be useful in determining "best care"?  Ain't our
job to determine that, just to provide the best care we can, to families,
to our patients, to everybody we can.  I strongly doubt you dissagree?

On Sun, Oct 28, 2012 at 10:29 AM, [log in to unmask] <[log in to unmask]> wrote:

> I'm just saying...if it were myself or my family member or friend, I'd
> want my money's worth, not to mention a thorough exam. Just do it. More
> energy is expended trying to get out of something than just may be useful
> in determining best care.
>
> Connie Mccoy
> Sent from my Verizon Wireless Phone
>
> ----- Reply message -----
> From: "Andrew Bebry" <[log in to unmask]>
> To: <[log in to unmask]>
> Subject: Entire leg vs to knee venous
> Date: Sun, Oct 28, 2012 11:47 am
>
>
> My vote is for groin to ankle, I guess that is the same for most serious
> vascular techs.  I have the same stories about calf clots that others did
> not find (because the calf was not important enough to scan I guess).  A
> Bebry
>
> On Sun, Oct 28, 2012 at 11:24 AM, Larry Needleman <[log in to unmask]>wrote:
>
>> Let me preface this by saying I work with both the IAC and Radiology
>> standards and my own lab scans from thigh to ankle.  Medical staff, not
>> administrators (or anyone with a stop watch), should determine how medical
>> testing gets performed.
>>
>> But not everyone who scans to the knee (and not below it) is jeopardizing
>> patients or even doing a bad job.
>>
>> BTW, the AIUM-ACR standard DOES recommend scanning below the knee
>> when the study does not explain the patient's symptoms, e.g. calf pain
>> with a
>> negative femoropopliteal study.
>> "Symptomatic areas such as the calf generally require additional
>> evaluation
>> and additional images if the cause of the symptoms is not readily
>> elucidated
>> by the standard examination."
>> "The patient presentation, clinical indication, or clinical management
>> pathways
>> may require protocol adjustments such as more detailed evaluation of the
>> superficial venous system, evaluation of the deep calf veins, or a
>> bilateral
>> study."
>>
>> While it is true that many DVT are totally or in part below the knee,
>> there are
>> reasonable people who think scanning below the knee is NOT necessary for
>> all
>> patients.
>>
>> Many centers, especially Europeans and North American internal medicine
>> groups, use 2 thigh to knee ultrasounds a week apart. This requires two
>> scans
>> for moderate to high risk groups and no further scanning for low risk
>> groups
>> or those with negative d-dimer (I recognize how few patients get good
>> evaluation before coming to a lab and this is one reason while I
>> personally
>> support the complete examination). This approach is well researched and is
>> safe.
>>
>> The current anticoagulation guidelines from the Chest Physicians support
>> this.
>> The chapters are hundreds of pages long and have a VERY long chapter on
>> diagnosing DVT. The guidelines do not recommend treating everyone with
>> calf
>> DVT and support tailoring imaging to diagnose treatable conditions rather
>> than
>> all DVT (i.e. calf DVT)
>>
>> How did they come to this conclusion.
>> 1) Very few people evaluated have DVT, they have something else.
>> 2) The minority of patients with calf DVT will propagate to above the knee
>> (about 20%).
>> 3) Larger veins are more likely to cause symptomatic PE, calf veins not
>> at all
>> or only rarely.
>> 4) There is weak evidence that treating calf DVT affects the rate of
>> chronic
>> venous insufficiency or recurrent DVT. (Obviously more work needs to be
>> done
>> since it makes some sense that treating a disease earlier should help).
>> 5) The risks of anticoagulation are real and the risks of overtreating
>> insignificant calf DVT may outweigh the benefit of treating calf DVTs
>> which
>> have a more aggressive natural history.
>>
>> 1.      Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ, for
>> the American College of Chest Physicians Antithrombotic Therapy and
>> Prevention of Thrombosis Panel. Executive Summary: Antithrombotic Therapy
>> and Prevention of Thrombosis, 9th ed: American College of Chest Physicians
>> Evidence-Based Clinical Practice Guidelines. Chest. 2012Feb.6;141(2
>> suppl):7S–47S.
>> 2.      Bates SM, Jaeschke R, Stevens SM, Goodacre S, Wells PS, Stevenson
>> MD, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of
>> Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based
>> Clinical Practice Guidelines. Chest. 2012Feb.6;141(2 suppl):e351S–e418S.
>>
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