HOLY MOLY: I found one of the MAJOR autonomic tests WEST of Mayo!!!

[Heiferly]

I found a QSART WEST of MINNESOTA!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Wooohoooooieeeeee!!!!!!!!!!!!!!

http://www.ohsu.edu/xd/research/centers-institutes/neurology/neuromuscular-disease-center/patients/autonomic-testing-qsart.cfm

My eyes almost fell out of my head.  Where have they been hiding this?  I don't have details at this point on this center, but I wanted to sound the alarms ASAP because this a HUGE lead on what could be a MAJOR breakthrough on all our dysauto folks out WEST seeking a fully equipped testing center.  QSART is one of the make-or-break tests on my list of autonomic tests that separate "the wheat from the chaff" when it comes to finding truly fully equipped testing centers, so this at least looks promising.  I'll post more details as I find them.  

How exciting!!!  Party time!!!

[Heiferly]

No problem, anytime.  :-)  

[Kavbear]

You weren't condescending at all! I am just so frustrated that I can't get something out the way I want to, its the only constant in my life ;-)

My problem is Amazon, I can get it to open and then search but it won't let me open the pages that the search comes up with. It shows the pages to the right but you can't click on them.
I do have pages from the Primer on the Autonomic Nervous System.  
I do not have the second.
I was able to read about the QSART neuropathy, I am not going back up to the links but I think I read a second round of things you posted and/or then did a search myself.

I had all the autonomic tests done at once and after I saw my main doctor at the Mayo. I had to stay a second week and my main doctor was gone on vacation, so once I got home and got my medical file and then saw  answers to tests that  had not been explained in detail like with the Orthostatic Intolerance and POTS.

Thanks for your help!

[Heiferly]

Sorry for the unnecessary URL explanation; I hope that didn't come off as condescending.  It's hard to know sometimes where the disconnect is happening as people have such varying levels of expertise when it comes to computer/internet usage.  

If the links aren't working for you, what you may be able to try is searching directly for the aforementioned texts yourself, then clicking on the "look inside" links on the books' pages on amazon.com, then following the rest of the instructions I gave above as given.  

The first URL is for Primer on the Autonomic Nervous System, Second Edition (in paperback) by David Robertson and the second is for Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System (in paperback) by Christopher Mathias.

Let me know if that still doesn't work for you, and I'll try to figure out what the problem is.  I may have to run it past our MedHelp tech people to see if they have an idea in that event, because I'm not quite sure what else could be going on.  If that doesn't work, let me know if you're able to get the "look inside" feature on amazon.com to work on any other books on the site (just pick something at random to test it out).  Maybe the problem is a pop-up blocker on your browser or something?  Although ... I have a pop-up blocker and it doesn't interfere with that feature so I'm not sure if that could be it.  Dunno, I have several ex-geeks myself (through dating), and only about as much IT knowledge as I gained through osmosis through those relationships.  :-p

Oh, as for "real" words about the Valsalva ... the only real word I know about Valsalva is uh ... Valsalva.  Unless "blow" is technical jargon.  ;-)  In my humble opinion, sometimes blowing into a tube is just blowing into a tube.  :-p

[Kavbear]

Yes Valsalva! Mine was ok as long as I only blew the thing to 20 not 40, which they said I needed to keep the mercury (or whatever the silver ball is now), but the summary says I passed (I still can't remember the "real" words, sorry)

I understood the link/URL thing. In a former life I had a larger vocab. and was married to a computer geek extraordinaire ;-)
Hopefully next one will include my vocab. they can keep the geek.

[Heiferly]

Valsalva is the one you're thinking of, I think.

Those "links" above aren't really links, they're just URLs.  No URL I post on MedHelp will render into a link unless it is on the MedHelp.org domain.  In order to go to that site, you need to copy the URL (highlight it with your mouse, then right click and click on "copy" in the drop-down menu that appears) then paste it into the navigation bar (up top where it currently says "http://www.medhelp.org/posts/Dysautonomia-Autonomic-Dysfunction/HOLY-MO...etc.";) of your browser (start with a blank navigation bar either by opening a new tab or window or by deleting the URL currently in the bar; right click in the navigation bar and click on "paste" in the drop-down menu that appears; hit return).  This applies for all URLs that are not "hotlinked" (not highlighted in blue and thus cannot be clicked on to navigate directly to the "linked" site, not just here on MedHelp but anywhere on the internet or in email.

I hope that helps answer your issue with the link.  If not, let me know and I'll try to figure out what the problem is.  :-)

I'll get you more info on the Valsalva when I get a minute.  
-Heiferly.

[Kavbear]

Thanks so much! I tried opening the first links you posted but I could not get them to open (I am sure it was me)
I do believe that is the book they have at the Mayo patient education center, so I may have it already.
I did find a new book by Dr. Low (well a rewrite) that says it addresses all autonomic things, even those left out prior and more well known like Migraines (I did not know that Migraines were a autonomic issue?!)
The book of course is close to $300.00

I am going to read your information and hope to get better educated about the QSART.
I then need to look into the Va?? )The test you blow into while air blows back)

I had several things going on a once since they did everything at once (having me lay down on TT (which was the most comfortable surface I have been on) strap me in, then QSART, then the Va?? blow test (maybe even while I was having the QSART.
I was so tired and made the mistake of eating before and took extra meds before lunch because I was so anxious (I wonder if that affected my BP and pulse, it was a benzo.)

A hunting we will go, I think it would be easier and cheaper to go to medical school myself and treat myself.....I came home so hopeful that I would feel better so fast and its record hot here and it's only June and I am backsliding because I am not outside walking.

[Heiferly]

It means that there may be small fiber autonomic peripheral neuropathy.  This gives insight into the cause of your symptoms, and may prompt further testing to look for a (possibly treatable) cause of the neuropathy.  For example, if the neuropathy is caused by an autoimmune disease, treatment for that might in some circumstances halt the progress of the disease, stopping it from damaging additional nerves and preserving whatever nerve function the patient has remaining.  Between the QSART and other nerve testing (such as specialized biopsy targeted toward examining small fiber nerves), doctors can also quantify the extent of existing nerve damage which may be useful in giving a more complete picture of a patient's case.


http://www.medhelp.org/medical-information/show/2287/Autonomic-neuropathy
http://www.medhelp.org/medical-information/show/74/Peripheral-neuropathy

http://www.nlm.nih.gov/medlineplus/ency/article/000776.htm

http://www.neuropathy.org/site/PageServer?pagename=homepage


The links I gave you in my earlier post are much more specific about how the QSART results are interpreted, though they're pretty heavy in medical jargon.

[Kavbear]

Thanks so much. I have not read your information but if I started there I would forget to respond.
I know what the QSART is and works I am wondering what it means when my foot does not sweat lie it should,  I was very unclear. I am thinking your link will have something.
While at Mayo I checked out and copied everything they had on the autonomic nervous system that was in a medical text book. I think it might have QSART in my pages but once again I think it explains the test, I need to look at it again.

[Heiferly]

Yes, Dr. Blair Grubb is here in Ohio.  Actually, it's a bit skewed to give Grubb credit for most of the POTS research.  He has done a tremendous amount of syncope research, and did some of the early research on POTS, but significant breakthroughs on POTS have come from several sources:  Dr. Low et. al. at Mayo, the late Dr. Streeten ( http://hyper.ahajournals.org/cgi/content/full/37/4/1045 ), Dr. Robertson/Dr. Raj et. al. at Vanderbilt, Dr. Mathias et. al. of London (St Mary's Hospital & National Hospital for Neurology and Neurosurgery), Dr. Julian Stewart et. al. of New York Medical College, Dr. Fouad-Tarazi et. al. at Cleveland Clinic, and others (sorry if I left out a "biggie" from this list).  

As for what QSART does, it is looking at the function of small fiber autonomic nerves.  It looks at your sweat production specifically, because if these small fiber peripheral autonomic nerves are working properly, they should be able to stimulate localized sweat production when properly stimulated as they are by the device used in the QSART.  (I just used "stimulate" twice in the same sentence.  I know, I should have used the thesaurus or found a better way to explain that but I'm still really not doing that well, so bear with me.  Sorry!)

QSART stands for quantitative sudomotor axon reflex testing.  Here are a bunch of links that can perhaps give a bit more explanation than I just did:

This first link should take you to the "look inside" feature.  If not, click on "click to look inside" on the corner of the picture of the book to get there.  Then put "sudomotor" in the search box and hit enter.  From the options that pop up, look for page p.229.  Sorry, you may need a magnifier to read it but it's WAY cheaper than buying the book, LOL.  There are Zoom buttons at the top edge of the window, or you can use the zoom function of your browser (usually under "view" in the menu if that's a choice next to file, edit, etc.).

http://www.amazon.com/Primer-Autonomic-Nervous-System-Second/dp/0125897626/ref=sr_1_1?ie=UTF8&s=books&qid=1276568639&sr=1-1#reader_0125897626

Same as above, search inside this book, this time for "qsart."  Go to "page 149." Note that the page numbers must include the front pages, because they don't line up with actual pagination of the text.  So once you're viewing the text, you'll see it says you're on page 133 where the Quantitative Sudomotor Axon Reflex Test overview begins.  It continues all the way through page 137.  You should be able to scroll down (or use the right arrow to "flip pages") and view all of these pages continuously without missing anything (not always the case when you find a section in this preview mode--so we lucked out!).


Same here; search "qsart."  Go to page 264.  It's two pages long.  (TST description follows for anyone interested.)

http://www.amazon.com/Autonomic-Failure-Textbook-Disorders-Publications/dp/019262850X/ref=sr_1_20?ie=UTF8&s=books&qid=1276569707&sr=1-20#reader_019262850X


By the way, I've plugged before but if you can get your hands on these textbooks through interlibrary loan and are able/willing to slog through the medical jargon, these books are AWESOME resources for those wanting to up the ante and sink their teeth into some more substantial reading material on the autonomic nervous system and dysautonomias.  They also provide great footing for being able to better comprehend the material that comes through the pipeline in clinical trials and journal articles.

Okay, waaaayyy more than you likely wanted, LOL.  G'night guys.  I owe a few people some lengthy PM responses so I'm probably going to work on those tomorrow and then skip back here onto the forums if I'm able on Wednesday.  

[Kavbear]

Yes Low created QSART. What does it mean though?  I had it and my foot fails (isn't that scientific? I am in a fog today)
Do you have any information by chance?

Someone posted this article about a doctor in the NW:
http://www.bendbulletin.com/apps/pbcs.dll/article?AID=/20090531/NEWS0107/905310408
(I can't remember who posted it sorry)
It also mentions the name of a doctor in Ohio who has done most of the POTS research (I think)

Glad I am of such a help today....LOL

[Heiferly]

I've put a phone call into the laboratory that does their QSART, and they're going to have the technician call me back as they believe she's the one most likely to be able to know offhand which tests they do and do not have available.  My initial impression is that it is not a full facility, but that it is going to be more complete than anything we've found out West to  date, which is still great news for anyone closer to Oregon than Minnesota who doesn't have the means/desire to travel to the Midwest or doesn't absolutely need a full facility.

One thing that's particularly lucky, in my opinion, is that the QSART is such a valuable test in terms of what's available overall in the field of autonomic testing.  There were some excellent comments on the value of the QSART in one of the autonomic medical texts ... Low's [of Mayo fame], I believe, but don't hold me to that.  

If, as I also suspect, they have Valsalva testing at this facility as well, that in combination with tilt and the standard variety of lab work could really add up to a pretty solid facility.  I hope they also have some docs with expertise in our field.  I'm just SO excited to FINALLY have good news for you folks out WEST  (or at least Northwest)!!  I'd jump up and down if I weren't sick, LOL.

BIG HUGS to all our NW people!!  I hope this turns out to be a breakthrough for someone or someoneS.  (I know there's no such word.  Shhhhh.)

-Heiferly.