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Well... I think sometimes ...this is exactly what Dr B didn't not want to see.
There is no classification of reflux - either it is there or not, there is no "size" of a vein that dictates a patient's symptoms or need for treatment.
Reflux at the confluence is not what makes a determination of treatment, in fact,  it can be found in anyone if you place your Doppler in a vicinity of a valve.
  These are all things that came after he left the building. Insurance companies use whomever fits their needs, in all areas of medicine.  I saw that when he fought Aetna to get the VNUS approved and off the "experimental" list.

                As he use to say at the end of the day.."so what did we learn today?" Everyday is a new adventure, hope you all have a great week end! Eclectic is Good!
Lisa


From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Nancy Williams
Sent: Thursday, January 23, 2014 7:45 PM
To: [log in to unmask]
Subject: Re: Non saphenous vein reflux

Laughing out loud! We are such an interesting, eclectic group :-)

Nancy Williams

On Jan 23, 2014, at 10:35 PM, "Bill Johnson" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
I never cringe from being referred to as a radical.  I can only assume I have been on more than one "watch list" since my anti-war activities in the sixties.  That was clear when two "plain cloths" guys showed up at my folks house looking for me in 1968.  They asked why I did not show up for induction in the Army.  Well I was in the Navy boot camp in San Diego. I guess that Watch List ended, but I am not na´ve enough to think they stopped there.

I think, if the Radiologists have a list, no I am no I am not that paranoid, but I assume I am on their list, as well as others.  Please do not tell anyone I live in Port Townsend, WA.  Opps.

On Thu, Jan 23, 2014 at 8:58 PM, Nancy Williams <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Aw Bill, you're one of my favorite radicals, I love your rants...although I'm certain my association with you has put me on more than one watch list, lol. This is why I love Flownet, perspective - I'm all about some perspective. I do love learning from you all- which is why I always kick myself in the tail when I hit send before I "review" my post so I don't read so darn snarky.

Nancy Williams

On Jan 23, 2014, at 9:51 PM, "Bill Johnson" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
To all of you (us) Nancy spoke out.  I hope all of us can and will do that, when the need occurs.  I am known for my rants.  I can only encourage all of you to rant when you are faced by ethical questions like this.  Best regards, Bill

On Thu, Jan 23, 2014 at 8:38 PM, Nancy Williams <[log in to unmask]<mailto:[log in to unmask]>> wrote:
Thanks, this is great. I appreciate you sharing. I'm sure you are correct about the interpretation. Again, to all who read my previous comment I hope you can appreciate that my frustration is with the insurers who seem to be asking me to provide information and documentation not relevant to the procedure being requested and not to Jason who graciously responded only to be harangued by me for his trouble. My twin sister will tell you in all seriousness, sometimes I am an @$$...it does not go unnoticed.

Nancy Williams

> On Jan 23, 2014, at 9:30 PM, "Registered Vascular Solutions" <[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
> Nancy,
>
> It most likely has to do with the verbiage in the interpretation.  We have no problems (and we get a lot from other vein centers that are not happy).  I agree most of the time the SFJ is preserved as well as the epigastric and very often an incompetent accessory that the previous practice ignored.
>
> You can state that the right great saphenous vein has been closed previously from the saphenous-femoral junction to the proximal calf, however significant reflux is visualized in the native great saphenous vein in the proximal, mid and distal calf as well as tributaries of the great saphenous vein.  There is proximal tibial perforator measuring 4.3 mm. With a reflux time of 1,240 msec. The native great saphenous vein measured 5.6 mm. in the proximal calf and has a reflux time of 4,350 msec. Associated tributaries are visualized at a, b and c.........
>
>
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