Author name: bethfloyd

evaluation of small fiber neuropathy

Evaluating Peripheral Neuropathy


Peripheral neuropathy is a condition that occurs when the nerves in the peripheral nervous system become damaged. Symptoms can include pain, numbness, tingling, and weakness in the affected area. Motor skills can also be affected, resulting in slower reflexes and difficulty walking.

There are millions of Americans that suffer from some type of peripheral neuropathy. Estimates suggest that 25-30% of all Americans will be affected by some kind of peripheral neuropathy at some point in their lives.

This is why detecting signs of peripheral neuropathy in the early stages is crucial. The TM Flow System can be used in the evaluation of small fiber neuropathy that can lead to severe peripheral neuropathy. Early detection is the first step in halting the advancement of this serious condition.

Who is at Risk of Peripheral Neuropathy Complications?

People with diabetes are at a very high risk of developing peripheral neuropathy. Nearly 70% of diabetics are diagnosed with diabetic peripheral neuropathy. This leads to 54,000 diabetics undergoing an amputation each year.

In addition, certain cancers and tumors can result in peripheral neuropathy. Experiencing substantial levels of radiation from chemotherapy is also thought to play a hand in causing conditions to worsen.

Alcoholism, poor nutrition, and certain infections like AIDS and Lyme disease have also been linked to peripheral neuropathy.

Peripheral Neuropathy Symptoms

Since peripheral neuropathy affects different parts of the body, many symptoms can be associated with the term. Symptoms will vary depending on which type of nerves are damaged and their location in the body.

  • Varying degrees of numbness and a tickling sensation. This is often felt in the hands and feet but can spread elsewhere.
  • Experiencing different types of pain (throbbing, sharp, or burning pain)
  • Motor skills have worsened
  • Increased sensitivity. Things that weren’t a problem have become overstimulating.
  • Paralysis
  • Digestive problems
  • Extreme sensitivity to heat
  • Feeling dizzy or lightheaded

Peripheral Neuropathy Evaluation and Treatment

Clinical data suggest that sudomotor testing may be the most sensitive method for detecting peripheral small fiber neuropathy. (Low, et al.,2006).

Millions of Americans are impacted by some form of Peripheral Neuropathy, and millions more are at risk. We hope to help the lives of patients by spreading awareness. Early diagnosis is the key to slowing and hopefully stopping the process.



Peripheral artery disease

Peripheral artery disease awareness

September is PAD (Peripheral artery disease) Awareness month. PAD is a terrible condition that impacts millions every year. Despite this, only 63% of people over forty have heard of the disease.

We are doing our best to spread awareness and educate people about the potential dangers of PAD. A late diagnosis can mean life-altering complications for the patient. In some cases, an amputation may be necessary.

What is PAD?

Peripheral artery disease is a circulatory condition in which the amount of blood flowing to the heart, arms, and legs is reduced due to narrowing or blockage of the blood vessels.

This blockage is often the result of plaque buildup. The patient may begin to experience a number of side effects. These include:

  • A frigid feeling in the legs
  • A numbing sensation in the appendages
  • A weak pulse in the legs or feet
  • Painful cramping

If left untreated, the arteries that lead to the heart and brain can become hardened. Failing to begin treatment can increase the patient’s risk of suffering a heart attack or stroke. Amputation may become required if total loss of circulation occurs.

How to Treat PAD?

The good news is that in many cases, PAD can be treated. When detected early, diet, exercise, and taking certain medications is all that is required. However, treatment is rarely the issue. The problem is that many patients won’t realize they have PAD until the symptoms become severe.

Testing for PAD is a painless procedure. Using the TM Flow System, you can quickly determine a patient’s ABI (ankle-brachial index) by performing a five-minute test. This test measures how well blood is flowing throughout the body. An ABI test can determine the severity of the patient’s case of peripheral artery disease. Thanks to the TM Flow System, you can have your patient’s results in mere minutes.

Early detection is crucial for improving the prognosis of anyone suffering from PAD. Please help us spread awareness by educating those around you about the dangers of PAD.

Doctor with patient

How the TM Flow System can Help Diagnose Peripheral Artery Disease

Peripheral Artery Disease (or PAD) is a circulatory disease that can reduce blood flow to the limbs. It’s crucial the correct measures are taken against PAD. Case numbers are rising with no sign of it slowing. Current projections suggest that by 2050, 19 million Americans will contract PAD. People over the age of 65 are most likely to suffer from PAD, which is why it’s so urgent to catch it early.

Part of the reason PAD cases are on the rise is due to the fact that there is a general lack of knowledge and awareness about the disease. In addition, the absence of prevention practices, early detection and treatments are shockingly low for such a life-altering condition.

There was a 2006 survey where 2,500 adults over the age of 50 were asked if they knew about PAD. Of the sample size, 25% knew PAD was linked to a higher chance of having a stroke and only 14% knew PAD could lead to amputations.

PAD is one of the leading causes of amputations in the United States. Although PAD is largely preventable, 70% of patients who undergo PAD-related amputations die within three years of the surgery.

It is possible to combat PAD. Using a TM Flow machine, you can detect and diagnose diseases like PAD before it has the chance to become more severe. TM Flow tests are short (between 7 and 10 minutes), non-invasive and user-friendly. These machines can help with early diagnosis and can help us combat PAD.

TM Flow System

Ankle Brachial Index (ABI) made simple with the TM Flow System


Simple ABI Testing

What is the Ankle Brachial Index (ABI)?

The Ankle Brachial Index, or ABI, is a non-invasive test used to assess peripheral artery disease (PAD). The ABI is calculated by comparing the blood pressure in the lower extremities to the blood pressure in the arms. An abnormal ABI indicates narrowing the arteries and reduced blood flow to the legs. ABI can be measured using a device called the TM FLOW SYSTEM. A low ABI is often a sign of PAD, and patients with an abnormal ABI are at increased risk for cardiovascular events such as heart attack and stroke.

How can the TM Flow System help with ABI testing and diagnosis?

ABI testing with the TM FLOW SYSTEM is a simple, straightforward process that can provide valuable information for physicians and their patients.

The TM FLOW SYSTEM is a non-invasive diagnostic tool that can be used to measure ABI or Ankle-Brachial Index. ABI is a measure of how well blood is flowing to the extremities and is an important indicator of peripheral artery disease. The TM FLOW SYSTEM can provide results within minutes. The ABI measurement device is an easy system to use, making it an ideal tool for busy medical practices.

What are some of the benefits of using the TM FLOW SYSTEM for ABI testing and diagnosis?

The TM FLOW SYSTEM is a new tool that promises to revolutionize the field of ABI testing and diagnosis. The system is designed to be much more user-friendly than traditional methods, and it offers a host of benefits for both patients and clinicians. One of the biggest advantages of the TM FLOW SYSTEM is that it significantly reduces the amount of time required for testing. In fact, the entire ABI measurement process can be completed in just minutes, which is a major advantage for busy clinics.

If you’re interested in learning more about the TM FLOW SYSTEM, contact Primary Care Diagnostics, LLC today. We’ll be happy to answer any of your questions and help you determine if the system is right for your practice.

Peripheral Arterial Disease Testing

The TM FLOW SYSTEM is a non-invasive, in-office test, that performs three billable diagnostic tests:

  • Sudomotor test for small fiber neuropathy

  • ABI – Ankle-Brachial Index

  • ANS – Autonomic Nervous System

Today we will focus on PAD  or Peripheral Arterial Disease

15-19 million Americans are affected by Peripheral Arterial Disease (PAD). Peripheral arterial disease (PAD) occurs when plaque forms in the leg arteries that carry oxygen-rich blood from your heart to your arms and legs. Identifying Peripheral Artery Disease (PAD) can mean the difference between life and death. If left untreated, one in five people with PAD will suffer a leg amputation, heart attack, stroke, or death within five years.

With the number is increasing each year detection and diagnosis is coming to the forefront in Primary Care practices, Integrated Chiropractic clinics, and Podiatry clinics.

The most common test to diagnose PAD is the Ankle Brachial Index (ABI) examination.

The ABI is a simple non-invasive test that takes 3-5 minutes with the TM FLOW SYSTEM.

The American Heart Association (AHA) and American Diabetes Association (ADA) have both recommended annual ABI screenings for the following patients:

  • Patients with Type 1 Diabetes
  • Patients over 50 Patients at high risk

These are some reasons why PAD testing should be performed everywhere, rather than only by specialists:

  • PAD and small fiber neuropathy testing is quick and can be completed within five minutes
  • This test is reimbursable by Medicare and most insurances; therefore, it offers a good return on investment.
  • In order to improve patient outcomes, it is crucial to detect PAD as early as possible.

Autonomic Function Testing with the TM Flow System

TM FLOW System also provides Autonomic Function Testing and increases reimbursement to a Medicare Average of $300.00.

Vascular testing is not just for specialists

There are more than 19 million people with PAD in the United States alone, which makes it a common health condition that affects many patients. From point-of-care to hospital care to specialty practices, testing for PAD should be routine.

ABI systems are convenient and beneficial for businesses.

A quick PAD screening can be performed in-office and is non-invasive.  Here are a few reasons why PAD testing should be performed everywhere:

  • PAD testing is quick and can take as little as 5 minutes
  • The testing equipment produces an excellent ROI
  • Early detection of PAD is essential to improving patient outcomes and saving lives
  • PAD testing is reimbursable and has a national average CMS payment of $85 (Average 2022 Medicare)

PAD testing has excellent reimbursement.  The national average CMS payment for a basic screening is $85 (Average 2022 Medicare) so even our most advanced systems will pay for themselves after a few tests are performed.

Why it’s important to test for PAD

Benefits of PAD testing, include reimbursement (ROI) information for physicians.

If your patients have any of the following symptoms, they potentially have PAD

  • Cold feet
  • Skin discolored and dry on the lower legs
  • Pain when walking
  • Leg pain at night
  • Painful, heavy legs
  • Numbness or burning sensations
  • Wounds that won’t heal
  • Gangrene

Patients who have the following risk factors have a higher incidence of PAD:

  • Over the age of 65
  • Diabetic
  • Current or previous smoker
  • Kidney disease


  • People with PAD often do not display any symptoms.
  • Patients with early-onset symptoms, like pain while walking or cold feet, dismiss these changes as a normal part of the aging process or the result of another health issue, such as an existing heart condition.
  • Early symptoms could be a sign of PAD, which is treatable if diagnosed by a trusted health care professional.

Primary Care Diagnostics is a company dedicated to improving patient care and increasing practice revenue. 

To learn more about ABI Testing using the TM Flow Machine, contact Primary Care Diagnostics.

TM FLOW System – 3 Tests in One

The TM FLOW SYSTEM is a non-invasive, in-office test, that performs three billable diagnostic tests:


  • Sudomotor – Small Fiber Neuropathy

  • ABI – Ankle Brachial Index

  • ANS – Autonomic Nervous System

Contact us to learn more about the TM Flow System.


TM Flow System

Expand your ancillary testing with high-quality diagnostic equipment.

Primary Care Diagnostics is a company that helps providers expand their ancillary testing with high-quality equipment. From solo independent primary care doctors to large multi-specialty groups, physicians have seen significant increases in revenue by adding valuable diagnostic services and more sophisticated technologies like TM Flow Systems or ANS-1 Systems.

We are committed to providing high-quality medical testing equipment that brings integrity and compassion into the marketplace.

We find the best diagnostics medical equipment and we have established relationships with distributors across America.

We take pride in our ability to be available for any questions or concerns you may have. Our clients often come back because they know that if something comes up, we’ll make time for them.

We are excited to work with you and help enhance the patient care in your practice as well as add additional revenue.

Autonomic Nervous System Testing Equipment

TM Flow System

TM Flow Device
  • The TM Flow System is a user-friendly, non-invasive 7-10 minute diagnostic test
  • The results are easy to interpret 
  • Perform and bill for 3 CPT codes
  • The average Medicare Reimbursement is $300

We offer flexible financing on the TM Flow System

Interested in learning more about the TM Flow System?

Purchase TM Flow System
TM Flow System
ECG PC Based
PC Based ECG
PC Based Spirometer

TM Flow System

Autonomic & Vascular Function Assessments

TM Flow System is a non-invasive autonomic nervous system test that takes around 7 to 10 minutes. The system produces provider reports, as well as patient wellness reports.

The cost per TM Flow test is $2.50 and reimbursement for TM Flow Testing averages $300. Only 3 patients per month to break even on lease.

Bill for CPT Codes 95943, 95923 and 93922

Who can benefit from ANS Testing or the TM Flow Test?

Patients with symptoms of Autonomic Neuropathy or Peripheral Arterial Disease can benefit from the TM Flow Test. This test is a simple, non-invasive procedure that has been shown to be highly accurate in diagnosing these conditions and may lead to life-saving treatment options.

The American Diabetes Association recommends that all patients and people with type 1 diabetes be tested for autonomic dysfunction at the time of diagnosis, as well as 5 years after.

From American Heart Association (AHA) ABI testing is recommended for all patients over 50 with Diabetes, hypertension, high LDL cholesterol or smokers, and everyone over 70.

Primary Care Diagnostics offers flexible financing options to meet your needs. Contact us for more information about ANS Testing Equipment.

Announcing the VAT® ENGplus™ Combo System

AWV  Fall Prevention

Prevent Falls with an VAT® ENGplus™ Test

By age 60, more than half of all Americans have experienced an inner ear problem. A new study conducted at Johns Hopkins shows that adults over age 40 are 12 times more likely to have a serious fall because of an inner ear problem. You can prevent falls in your patient, if you know the cause, unfortunately, finding those causes often difficult.

Dr. Dennis O’Leary, a neurophysiologist at the University of Southern California School of Medicine, developed the VAT-ENGplus Combo System –  a combination of simple to use tests that evaluate the central and peripheral vestibular systems. Your technician or medical assistant can perform these tests in less than 20 minutes with immediate results and interpretation. That VAT-ENGplus Combo System tests the four ocular motor pathways responsible for maintaining balance, psychotic, smooth pursuit optogenetic, and the vestibular ocular reflex commonly called the vo are problems with any of these systems can cause your patient to feel off balance. The first segment of tests evaluates the central vestibular nervous system. A lightweight head strap with five electrodes monitors the head and emotions, the patient follows a moving target on the wall. During the second test, the patient moves his eyes in a rapid single movement as the light jumps back and forth at random intervals for 20 seconds. Test Results show the speed, accuracy, and delay of eye movements compared to the target. During the smooth pursuit test, the light moves continuously test results show whether the eyes kept up lagged behind, or jumped ahead. green and black stripes fill the visual field during the optogenetic test. As your patient watches each stripe. A reflexive II movement called a stagnant is generated and recorded. The test determines whether the speed of the eye movement is symmetric between the right and left sides. abnormalities within the psychotic smooth pursuit or optogenetic systems are consistent with central nervous system pathology. The vestibular autorotation test commonly called the bat is used to test the VR. The VR is the ocular motor system controlled by the inner ear that signals the eyes to move in exactly the opposite direction of the head during everyday activities such as turning, walking, or bending over. In the event of a mismatch, dizziness occurs.

During the VAT, the patient is asked to move her head back and forth to a tone played through the computer while following a target on the wall. As the tone gets faster, the patient moves her head faster. Side to side head motions test the horizontal canal at the inner ear while up and down motion to evaluate the vertical canal. Results compare the timing distance and speed of the eye and head movements. Abnormal results suggest peripheral vestibular pathology.

Dizziness is a frightening experience. You are your patients’ first and best resource to help join the growing number of physicians that are helping their patients stay on their feet while adding an additional source of revenue to their practice.

Learn more about the VAT-ENGplus Combo System here. 

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