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08/09/2024 Paul Kesselman, DPM
Replace Your Neck Stethoscope with a Hand-Held Doppler to Save Limbs (Martin M Pressman, DPM)
Kudos to Dr. Pressman for pointing something out which I have been preaching for my over 40+ years as a clinician. I first came aware of non-invasive vascular technology back in the late 1970s and early ‘80s during my undergraduate medical education at rotations at various VA hospitals in the Chicago area. In those days the machines were big, bulky and took up an entire room. Their costs and size relegated them mostly to large clinical or research facilities.
With computer technology eventually the machinery got more sophisticated and totally paper free and can integrate directly into your computer and eventually into your patient's EMR. Most cost 1/3 of what digital x-rays cost with many fitting into your brief case. The current machinery can combine pulse volume recording and photoplethysmography, which are far more sophisticated than Doppler, which can miss many small vessel diseases.
There are other technologies such as laser Doppler, Sp02, Skin perfusion pressure and others which are even far more sensitive to microvascular changes than Doppler. Even arterial duplex testing while having the capability of showing dynamic flow, often will not be able to show microvascular disease.
But Dr. Pressman is correct, in that podiatrists should at least be familiar with doppler technology at least as a "gatekeeper" to determine whether or not a patient requires more sophisticated testing. Whether you send those out or do those more thorough testing yourself, is not his point nor mine. These diseases must be caught early if we are to avoid more complicated and expensive care.
Beware though that screening testing with extremity vascular testing is not covered by Medicare and most third-party payers. Those who are performing these tests as a way of generating some additional revenue beware.
Performing these tests takes both time and skill to acquire. Done right they take some time and your results will be held to the same standards as any other professional (e.g., vascular surgeon, vascular lab, radiologist) performing these procedures. Performing these tests correctly will however provide significant results which can often save a limb and also guide you when to refer patients for either further testing or vascular surgery.
For more information on non-invasive vascular testing, one should study the testing technology available and review the anatomy in detail prior to leaping into purchasing any units. There were some very well written articles on this subject which can be found by doing a "Google Search" and researching some back issues starting in Podiatry Management (Nov/Dec 2006).
Once one has mastered arterial testing, non- invasive venous testing is also a skill one should aspire to acquire. Especially in those states which allow DPMs to treat many manifestations of lower extremity venous disease, performing venous testing is an essential test and just the beginning.
Paul Kesselman, DPM, Oceanside, NY
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