CT sufficient prior to Epidural?

[clubdeac]

If they didn't want you leaning forward why would they put the handles on there. Its not a question of most people lean back, its you can lean forward and have them pedal for a few minutes leaning forward.

what handle bars? 😉

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[soccrwz]

stationary ones, available at your nearest walmart
Schwinn 230 recumbent exercise bike

 

[Ducttape]

on recumbent bikes, the primary handles that ppl use are the ones on the seat. i see few ppl ever at the Y use the handles that are by the TV, except as a rest when they are changing the channel, and it doesnt change their spine angle.

 

[painfree23]

To answer ops question : yes it’s sufficient if MRI is not available. How we get started on stationary bikes with or without handles?

 

[lobelsteve]

on recumbent bikes, the primary handles that ppl use are the ones on the seat. i see few ppl ever at the Y use the handles that are by the TV, except as a rest when they are changing the channel, and it doesnt change their spine angle.

 

[SommeRiver]

Please stop. Do not ever again say that someone on a recumbent bike would lean fwd on the handles.

 

[soccrwz]

I will once again reiterate, the purpose of putting someone on the bike can be used to look at a vascular component, ie demand ischemia, and taking the walking component out. Its not a matter of opinion, many recumbent bikes have handles on the front, I didn't invent leaning forward on these bikes. Substitute stationary bike if you like. The point still remains you can take the walking component out and have them cycle and see if exercise while sitting takes this component out. If your not a fan fine, but still remains a poor man's options, I didn't invent this technique its been out there a while... ABI is still the gold standard. I hear they have the bikes in pink if that's your flavor

Also steve I think your camera's out of focus you sure you weren't trying to take a picture of the girl down the row 😉

 

[lobelsteve]

I will once again reiterate, the purpose of putting someone on the bike can be used to look at a vascular component, ie demand ischemia, and taking the walking component out. Its not a matter of opinion, many recumbent bikes have handles on the front, I didn't invent leaning forward on these bikes. Substitute stationary bike if you like. The point still remains you can take the walking component out and have them cycle and see if exercise while sitting takes this component out. If your not a fan fine, but still remains a poor man's options, I didn't invent this technique its been out there a while... ABI is still the gold standard. I hear they have the bikes in pink if that's your flavor

Also steve I think your camera's out of focus you sure you weren't trying to take a picture of the girl down the row 😉

60 min on level 12. Right from the office. Not a running day.

 

[MD87]

Related to the title of this thread: Patient who can't get an MRI but has cervical radiculopathy. Do you do ILESI without making sure there is epidural fat at the level you are entering? Drop down to T1/2? Is there always fat at T1/2? I've never had to drop down farther than that but I've only been doing this for a year. Do you increase the volume of injectate? I typically inject 3cc.

 

[irwarrior]

Patients can have palpable peripheral pulses and still claudicate or have atypical leg pain. The gold standard to exclude a vascular etiology for leg pain would be an exercise ABI. This should elicit the symptoms patient had and see a drop in ankle pressure (which Is abnormal). You can very rarely miss a popliteal entrapment issue even with exercise abi.

If the disease is in the aortoiliac system or even SFA, it can be pretty easily and successfully revascularized with just some local anesthesia and mild sedation.

Often for vascular claudication , I start of with a conservative approach of exercise regimen (dramatically improves walking distance) , cilostazol (50% improvement in walking distance). I also use high intensity statins in these vascular claudicants which prevent cardiovascular events and can improve walking distance. We also place these patients on an ace-inhibitor and some type of anti-platelet regimen (plavix (Caprie trial) or baby asa).

 

[clubdeac]

Patients can have palpable peripheral pulses and still claudicate or have atypical leg pain. The gold standard to exclude a vascular etiology for leg pain would be an exercise ABI. This should elicit the symptoms patient had and see a drop in ankle pressure (which Is abnormal). You can very rarely miss a popliteal entrapment issue even with exercise abi.

If the disease is in the aortoiliac system or even SFA, it can be pretty easily and successfully revascularized with just some local anesthesia and mild sedation.

Often for vascular claudication , I start of with a conservative approach of exercise regimen (dramatically improves walking distance) , cilostazol (50% improvement in walking distance). I also use high intensity statins in these vascular claudicants which prevent cardiovascular events and can improve walking distance. We also place these patients on an ace-inhibitor and some type of anti-platelet regimen (plavix (Caprie trial) or baby asa).

Are you a vascular surgeon

 

[irwarrior]

vascular interventional radiology. See and treat a fair amount of claudicants (mostly with medical management/exercise and if still significant symptoms will repair endovascularly).

 

[epidural man]

Patient is an elderly female with h/o cardiac stent on anticoagulation also with a pacemaker that is not compatible with MRI. She has lower extremity radicular pain. Ordinarily I would like to have a MRI so that I can see soft tissue pathology. There is a CT scan which notes that there "may be some mild canal and neur foraminal narrowing." Clinically pain is only on ambulation with no associated neurologic deficits by history nor in the office on exam. Would you proceed with intervention from here?

Absolutely do the ESI.

CT - no injection or tumor? Clinical picture sounds like disc pathology? Good....proceed with intervention.

You don't need the particulars that an MRI gives you.

 

[SSdoc33]

vascular interventional radiology. See and treat a fair amount of claudicants (mostly with medical management/exercise and if still significant symptoms will repair endovascularly).

appreciate the input.

so, YOU prescribe the statins, ACE inhibitors, plavix, and cilostazole? really?

 

[Orin]

so, YOU prescribe the statins, ACE inhibitors, plavix, and cilostazole? really?

A lot of IR folks are stepping in with clinics and medication management now. This is not rocket science, and those aren't controlled narcotics. The R/B/Os can be documented and the medical risks can be monitored with labs. There are academic and private places now where IR trial/implant/manage SCS and pumps in addition to the other more usual stuff. I suspect it will grow in the future.