As a final note, ABIs and lower-extremity segmental limb pressure (SLP) measurements alone are not an adequate test to diagnose the presence or absence of lower extremity arterial disease. As such, it is highly recommended that segmental pulse volume recordings (PVRs) or continuous wave (CW) Doppler waveforms accompany these pressure measurements. PVRs or CW Doppler waveforms are also necessary for Medicare reimbursement under CPT codes 92922, 93923, and 93924. The Fundamentals Symptoms of deep vein thrombosis include pain, tenderness, and possible swelling in one or both legs. This may also present with increased warmth in the skin of the affected leg, erythema, and a palpable cord or red streak along the course of a vein.

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First, don’t do bondage with a person you don’t know well or trust, and agree on a safe word in advance. “A safe word — any word besides ‘no’ or ‘stop,’ basically — allows the bottom person to be in character if she likes; when it’s time to stop, the safe word takes them out of the fantasy scene and interjects real needs in a clear way,” Queen says. Principles of Pressure Measurements for Assessment of Lower-extremity Peripheral Arterial Disease | USC Journal Several investigators have recommended using a three-cuff technique incorporating a wide thigh cuff (17–22cm width). Although this approach results in a thigh pressure measurement that accurately approximates the brachial systolic pressure, it prevents the ability to accurately differentiate inflow from outflow disease. These issues have prompted vascular practitioners to employ the four-cuff method in current clinical practice whenever possible (see Figure 2). This method is more specific in identifying disease locations. However, the use of a 12cm-wide cuff at high thigh in the four-cuff method more often than not results in ‘cuff artifact,’ except in very thin patients, because of the discrepancy between the cuff width and the limb diameter. This artifact is considered during SLP interpretation. Examination The ABI can be calculated by dividing the ankle pressures by the higher of the two brachial pressures and recording the value to two decimal places. The general diagnostic values for the ABI are shown in Table 1. The lower the ABI, the more severe the PAD. If ankle vessels are non-compressible or yield an ABI greater than 1.3, the practitioner should consider taking digit pressures at the great toes and calculating a toe–brachial index (TBI) to better assess arterial perfusion to the feet. This is often performed in patients in whom PAD is clinically suspected but results from the ABI are unreliable due to non-compressible vessels, such as in elderly patients or those with long-standing diabetes. Segmental Limb Pressure MethodologyHigh thigh pressures that are 50–60mmHg above the brachial reference pressure are not uncommon in obese patients. This cuff artifact can mask inflow disease if not taken into consideration. As vessel calcification can also create abnormal segmental pressure, it is helpful to correlate SLP values with waveforms taken at multiple levels using either Doppler or pulse volume recording. There are certain medical conditions that can preclude the performance of pressure measurements, such in cases where patients have deep vein thrombosis, a history of lower limb stent replacement, or recent saphenous vein arterial bypass grafting or are mastectomy patients. For people who have a day-to-day life of being constantly in control, juggling too many tasks with an overload of responsibilities, giving up control in the bedroom can be a huge turn-on,” says sexologist Emily Morse, host of the Sex With Emily podcast. “It allows them to tap into their bodies sexually and let go without worrying about anyone else’s pleasure but their own. The same goes for someone who is more passive in their day-to-day life. It’s arousing to be the dominant, to be the one in control, calling the shots and orchestrating the entire scene.” We’v also rounded up a few more cute and comfortable sets of sex cuffs great for beginners and experienced players. I’m a little freaked out by the idea of restraints. How can I make sure my partner and I both stay safe?

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Segmental limb pressure measurements were first described in 1950, where Winsor et al. used a narrow cuff (10x40cm) at the high thigh level with additional cuffs above the knee (10 or 12cm), below the knee (10 or 12cm), and at ankle levels (10cm). In the 1960s, Strandness and Bell found that although the atypically narrow high thigh cuff (generally, the thigh cuff is 12cm wide) resulted in artifactually elevated proximal thigh pressures, accuracy improved for the identification of aortoiliac disease. You can also incorporate the stoplight system (red, yellow and green) to let your partner know what’s good, what you may want to pause and talk about or slow down with and what’s a no-no. This is a great way for feeling out boundaries and comfort levels and keeping communication going.The PPG gain should be appropriately adjusted so that the opening arterial pulse pressure wave can be differentiated from artifact waves. A gain setting that is too high can cause artifacts that may mask the return of arterial pulsation during pressure-cuff deflation. Similar to ABI measurements, the leg pressure cuffs should be inflated to 10–15mmHg above the point where the Doppler or PPG signal is no longer discernable and the analog waveform tracing becomes flat-lined before initiating cuff deflation. This ensures that the artery is completely occluded—an important step since a significant difference can occur between the closing and opening pressures, or the points at which the arterial pulse ceases and reappears. The opening pressure obtained is used as the pressure value for each limb segment. Interpreting Segmental Limb Pressure Values From there, try kissing your partner on the lips, then slowly moving down, stopping to nibble and tease the nipples.