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. Several investigators have recommended using a three-cuff technique incorporating a wide thigh cuff (17–22cm width). A high thigh to brachial artery index (HTI) is calculated by dividing the high thigh pressures by the higher of the two brachial pressures.

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It may not be possible to take both brachial pressures in mastectomy patients if axillary node dissection was performed; one arm pressure will suffice in such a situation. 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.High thigh pressures that are 50–60mmHg above the brachial reference pressure are not uncommon in obese patients.

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The PPG gain should be appropriately adjusted so that the opening arterial pulse pressure wave can be differentiated from artifact waves. First, don’t do bondage with a person you don’t know well or trust, and agree on a safe word in advance. If this difference is seen, a repeat measurement of the right arm pressure will often provide a lower value.

Information provided is for reference purposes only and does not constitute medical advice or opinion. 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. From there, try kissing your partner on the lips, then slowly moving down, stopping to nibble and tease the nipples.

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This could also be modified to involve woman-on-top intercourse but with the bottom cuffed,” Queen says. 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).This allows those elements to remain very important and adds a touch of power play: Hands over head and bound exposes the breasts and gives her more of a feeling of being ravished. Acknowledgements: This article is edited and distributed by Touch Briefings and supported by Unetixs Vascular, which designs and manufactures advanced non-invasive vascular diagnostic systems that provide early detection of vascular disease.

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Why it feels so good:“This is pleasurable to both of you because you’re giving and receiving on your own terms,” she says. Sex isn’t supposed to be perfect, but it does get better when you stretch your sexual boundaries (to a certain point). Complications around the medial malleolus can mean that a Doppler angle of 90º to the skin surface might yield better signals for the posterior tibial artery. Endovascular stents are commonly used in the peripheral arteries to treat occlusive disease, and pressure measurements should not be taken over a stent due to risk of stent fractures.A patient presenting with critical limb ischemia may warrant a different initial examination from a patient presenting with intermittent claudication or an asymptomatic diabetic patient with no palpable pulses. Symptoms of deep vein thrombosis include pain, tenderness, and possible swelling in one or both legs. The Doppler probe should be held at 45º to the arm and positioned to obtain the strongest signal at the brachial artery. If using photoplethysmography (PPG), the sensor should sit snugly on the index or middle fingers of the patient, at which point a waveform will be seen pulsing on the instrument screen. This session ends when you say so or your partner can’t take it anymore because they just have to have sex with you now.