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| Back To the Basics- Diagnostic Tests for the Clinician lll |
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by Bob Blumm, MA, PA-C, DFAAPA - April 11, 2011
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This small series is by no means meant to be exhaustive but rather to refresh the clinician on tests that are known by the insurance carriers and by their patients and are rarely rejected. Do you remember a movie made about twenty years ago where people were placed in a capsule, shrunk and injected into the human body? They went through the circulatory system and then through all of the organ systems to observe nature as it demonstrated the miracles of the human being. This may have been the impetus of a test which as gained therapeutic recognition as it has the ability to be the eyes of the clinician through the digestive system.
Capsule Endoscopy or virtual endoscopy is the utilization of scopes to visualize the functioning of organs. Capsule endoscopy utilizes a vitamin sized pill -sized camera to visualize the digestive system using radiofrequency and a battery to record this interesting transit, particularly through the small intestine. It has the ability to discover tumors, polyps, cancers, Crohn’s disease and bleeding. There is no need to send a rescue vehicle through the distal tract to retrieve the pill as it is dispelled flawlessly through the large intestine within 10 hours. Woody Allen gave us a glimpse of this when he produced a movie utilizing the assembling of sperm cells and their journey looking for the egg to impregnate in the GYN tract. These movies have the ability to change fantasy into reality.
Colonoscopy is another procedure advertised as a public service segment by Katie Curic to convince people of the need to utilize Colonoscopy as a means of preventing deadly colon cancer. She choose this procedure because of its simplicity and availability and for its ability to observe and biopsy suspicious sites and polyps. Women are more prone to have this test than men as men seem to have an aversion for anything entering their body habitus and they fear the embarrassment. The colonoscope is placed gently into the anus and begins and ends by going from the anus to the cecum with a return trip that is on a search and destroy mission, taking captive, polyps that may be precancerous. The bowel is filled with air to facilitate the process of advancing the tube and requires a prep a few days prior to the procedure which is why it is disliked by many patients. Obviously, we need to reduce this time in order to have compliance and have the ability to look at glistening walls of colon rather than stained sewer pipes and I am sure that the future will incorporate a much easier manner to prep a patient. Did I mention that this is a painless procedure utilizing versed and propofol.
As we move from the bowels we go to the heart of the matter and look at Doppler Echocardiograms. This sis the technique of using pulsed, high frequency sound waves to evaluate the position, size as well as the movement of the heart and vessels and also includes velocity, turbulence and with the addition of color the direction of a given stream, can be determined along with its hue. TDI is a more recent addendum which is utilized to evaluate longitudinal myocardial function as well as systolic and diastolic dysfunction. This is useful in determining circulation to the hand and adequate collateral circulation to the hand prior to harvesting a radial artery prior to CABG.
Echocardiogram has become one of the most significant and important tests for the patient whose ECG may not demonstrate a problem whereas the “echo” has the ability to utilize those same high frequency sound waves to evaluate the size and position of the hearts, its chambers and walls, its valves and blood direction as well as the great vessels. Studies may be done in M-mode, (one dimensional or 2-D (picture of the organ or 3 –D The probe can be done by placing it over the chest as a transthoracic study to demonstrate the direction of a blood flow through an area or placed through the esophagus as a TEE which is not obscured by the sternum or ribs.
 Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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