All new consultations carried out by patients in the NZ school undergo basic
vascular assessment irrespective of age.  This includes a full medical
history, pulses, colour assessment, temperature, blood pressure, observation
for trophic changes, skin texture andcapillary refill. Patients undergoing
assessment at the Diabetes Unit have a more thorough vascular assessment for
the purposes of monitoring their medical condition. As well as the above
they undergo, Beurger's elevation, "pole test", ABI, Allen's test and venous
reflux test if deemed appropriate.  Of course in both cases referral for
further investigations outside of our expertise are made as necessary. In
general, older people do demonstrate increased vascular insufficiency and
are monitored accordingly.  the pharmacological status of the patient is
another important consideration when you assess vascularity ( or any other
system for that matter) as is general health and well-being at the time of
consultation, including the stresses caused by the fact they are undergoing
a medical consultation.  It would be interesting to find out if the
practitioners status has an effect???!!(student versus registered
practitioner)

-----Original Message-----
From: Jill Pellizzon [mailto:[log in to unmask]]
Sent: Wednesday, 11 October 2000 03:39
To: [log in to unmask]
Subject: Peripheral Arterial Disease


To All, but particularly our educators!
 
I am in the process of doing a literature review on peripheral arterial
disease - the relevance to Podiatry, identification, diagnosis, prevention
and treatments.  Most of the literature seems to discuss assessment via ABI,
TcPO2 and pulse waves once obvious or advanced symptoms are evident.  
 
Is there anyone who actually uses the above methods to 'screen' those
patients whose age/lifestyle/history suggests potential risk for PAD
routinely even though a person may not be symptomatic (i.e. Intermittent
Claudication/Rest Pain/Skin lesions) - thereby providing earlier
identification and monitoring????  Is this not feasible due to cost, time
etc????  With an increasingly aging population and large numbers of
diabetics, is this an avenue you (all) think Podiatrists could be involved
in for benefits in limb preservation and reduction of CHD/CVD???
 
Also, are these techniques taught now in Podiatry courses (particularly
Australia, NZ, UK)?
 
I look forward to reading your replies - any current views and advice will
be much appreciated.
 
Jill Pellizzon

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