In-Office Testing

The ABI is a simple, reliable test to detect peripheral arterial disease or PAD. Simply put, PAD is a narrowing of the blood vessels outside of your heart. PAD usually affects your legs but can affect other areas of the body too. Your doctor will discuss this with you in more detail if they suspect or confirm that you have PAD. Patients who complain of leg discomfort or numbness in the leg may be candidates.

One way to detect PAD is to have an ABI test. It is important to know if you have PAD, as patients with it may have a higher risk of heart disease or stroke.

What to Expect If You Have an ABI

ABI is quick (approximately 30 minutes), non-invasive, and provides instant results.

There is no special preparation for the test. You may eat, drink and take your normal medications and supplements on the day of the test.

First, you will be asked to remove your socks or stockings. A specially-trained medical technician will then place a blood pressure cuff on your leg and take measurements. At the same time, he or she will listen with a small probe to the artery in your leg. The probe is connected to a small ultrasound machine.

This will be done on each leg and then the blood pressure in your arms will be measured using the same cuff.

When the test is over, the technician will provide the results of the test to your physician who will discuss the findings and any treatment with you. Your doctor may refer you for further testing or prescribe medications based on the results of the ABI.

Who Should Not Have an ABI

Patients who have a DVT (deep vein thrombosis) are not good candidates for an ABI test.

Blood pressure monitoring involves wearing an ABPM, an ambulatory blood pressure monitor. It is a small machine, about the size of a portable radio. You wear it on a belt. The blood pressure cuff on the monitor can be worn under your clothes without anyone seeing it.

This machine records and lets your doctor find out what your blood pressure was every 15 to 30 minutes of a normal day. The information collected by this machine can help you and your doctor see if your blood pressure treatment is working.

Your doctor may want you to use an ambulatory blood pressure monitor for one or more of the following reasons:

• If you have “borderline” high blood pressure.
• If you and your doctor can’t keep your blood pressure under control.
• If you have blood pressure problems caused by your other medicines.
• If you have changed your medicine.
• If you are pregnant and have high blood pressure.
• If you have fainting spells.
• The monitor may help your doctor find out if you are a person who only has high blood pressure when you are at the doctor’s office. This is called “white-coat hypertension.” If you have this kind of hypertension, you may not need to take medicine.

What happens when I wear the monitor?

The small blood pressure cuff that is connected to the monitor will automatically check your blood pressure about every 30 minutes, even while you are sleeping. You also will be asked to keep a diary of your day’s activities, so your doctor will know when you were active and when you were resting. Some people feel a little sore from the frequent pressure checks. Some people get a rash but it usually goes away without treatment.

After 24 hours of monitoring, you will take the machine and your diary to the doctor’s office. The blood pressure information is transferred from the monitor to a computer. The computer helps the doctor make sense of the information. Your doctor will review the information with you and decide if your treatment program is working or if you need to make changes.

Holter and event monitors are medical devices that record the heart’s electrical activity. Doctors most often use these monitors to diagnose arrhythmias. Arrhythmias are problems with the speed or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

Holter and event monitors also are used to detect silent myocardial ischemia. In this condition, not enough oxygen-rich blood reaches the heart muscle. “Silent” means that no symptoms occur.

These monitors can also check whether treatments for arrhythmia and silent myocardial ischemia are working.

Holter and event monitors are small, portable devices. You can wear one while you do your normal daily activities. This allows the monitor to record your heart for a longer time than an EKG.

Some people have heart rhythm problems that only occur during certain activities, such as sleep or physical exertion. Using a Holter or event monitor increases the chance of recording these problems.

Although similar, Holter and event monitors aren’t the same. A Holter monitor records your heart’s electrical activity the entire time you’re wearing it. An event monitor only records your heart’s electrical activity at certain times while you’re wearing it.

Please visit our Pulmonology page.

Vaccines provide an important defense against preventable diseases. At Internal Medicine of Milford, P.C., we vaccinate against most vaccine-preventable diseases. Some immunizations are vital for most adults, especially senior citizens. Others are appropriate for only certain people. We follow the recommended adult immunization schedule revised annually by the Centers for Disease Control and Prevention (CDC).

Why might some adults need vaccines?
Some adults incorrectly assume that the vaccines they received as children will protect them for the rest of their lives. Generally, this is true, except that:

• Some adults were never vaccinated as children
• Newer vaccines were not available when some adults were children
• Immunity can begin to fade over time
• As we age, we become more susceptible to serious disease caused by common infections (e.g., flu, pneumococcus)

Watch out for announcements about our annual influenza clinics, usually held on Saturdays in the months of September-November.

Spirometry is the classic pulmonary function test which measures the volume of air inspired or expired as a function of time. It can monitor quiet breathing and thereby measure tidal volume, and also trace deep inspirations and expirations to give information about vital capacity. Please check our Pulmonology page for more information.

Prothrombin time (PT) is a blood test that measures how long it takes for blood to clot. A prothrombin time test can be used to check for bleeding problems. PT is also used to check whether medicine to prevent blood clots is working.

A PT test may also be called an INR test. INR (international normalized ratio) stands for a way of standardizing the results of prothrombin time tests, no matter the testing method.

Blood clotting factors are needed for blood to clot (coagulation). Prothrombin, or factor II, is one of the clotting factors made by the liver. Vitamin K is needed to make prothrombin and other clotting factors. Prothrombin time is an important test because it checks to see if five different blood clotting factors (factors I, II, V, VII, and X) are present. The prothrombin time is made longer by:

• Blood-thinning medicine, such as heparin. Another test, the activated partial thromboplastin time (APTT) test, is a better test to find out if the right dose of heparin is being used.
• Low levels of blood clotting factors.
• A change in the activity of any of the clotting factors.
• The absence of any of the clotting factors.
• Other substances, called inhibitors that affect clotting factors.
• An increase in the use of clotting factors.
• Abnormal prothrombin time is often caused by liver disease or injury or by treatment with blood thinners.

Another blood clotting test, called partial thromboplastin time (PTT), measures other clotting factors. Partial thromboplastin time and prothrombin time are often done at the same time to check for bleeding problems or the chance for too much bleeding in surgery.

Why Is It Done?

Prothrombin time (PT) is measured to:

• Find a cause for abnormal bleeding or bruising.
• Check to see if blood-thinning medicine, such as warfarin (Coumadin), is working. If the test is done for this purpose, a PT may be done every day at first. When the correct dose of medicine is found, you will not need so many tests.
• Check for low levels of blood clotting factors. The lack of some clotting factors can cause bleeding disorders such as hemophilia, which is passed in families (inherited).
• Check for a low level of vitamin K. Vitamin K is needed to make prothrombin and other clotting factors.
• Check how well the liver is working. Prothrombin levels are checked along with other liver tests, such as aspartate aminotransferase and alanine aminotransferase.
• Check to see if the body is using up its clotting factors so quickly that the blood can’t clot and bleeding does not stop. This may mean the person has disseminated intravascular coagulation (DIC).

How Should I Prepare?

Many medicines can change the results of this test. Be sure to tell your doctor about all the nonprescription and prescription medicines you take, as well as any supplements or herbal remedies you use.

How Is It Done?

The health professional drawing blood will:

• Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
• Clean the needle site with alcohol.
• Put the needle into the vein. More than one needle stick may be needed.
• Attach a tube to the needle to fill it with blood.
• Remove the band from your arm when enough blood is collected.
• Put a gauze pad or cotton ball over the needle site as the needle is removed.
• Put pressure on the site and then a bandage.

What Are the Risks?

There is very little chance of a problem from having a blood sample taken from a vein.

You may get a small bruise at the site. You can lower the chance of bruising by keeping the pressure on the site for several minutes.

In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.

Ongoing bleeding can be a problem for people with bleeding disorders. Aspirin, warfarin (Coumadin), and other blood-thinning medicines can make bleeding more likely. If you have bleeding or clotting problems, or if you take blood-thinning medicine, tell your doctor before your blood sample is taken.

What Affects the Test?

Reasons you may not be able to have the test or why the results may not be helpful include:

Taking medicines that can affect the action of blood thinners (such as warfarin) and vitamin K. These include antibiotics, aspirin, cimetidine (Tagamet), barbiturates, birth control pills, hormone replacement therapy (HRT), and vitamin K supplements.

Having severe diarrhea or vomiting that causes fluid loss and dehydration may make the PT time longer. If diarrhea is caused by poor absorption of nutrients, vitamins, and minerals from the intestinal tract (malabsorption syndrome), the PT may be longer because of a lack of vitamin K.

Eating foods that have vitamin K, such as beef liver, pork liver, green tea, broccoli, chickpeas, kale, turnip greens, and soybean products.

Drinking a lot of alcohol. Taking laxatives. Taking some herbal products or natural remedies.