The Villages Voice - October 2014

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Villages Health = Peripheral Arterial Disease

by Dr. Christine Stopyra

TALKING ABOUT PERIPHERAL ARTERIAL DISEASE By Dr. Christine Stopyra   A few weeks ago, a 68 year old gentleman from New York came to see me in clinic. He had just finished a round of nine-holes of golf at Pelican. He pointed to a small bandage on his left calf, and said, “Dr. Stopyra, I want you to look at this. I think a bug bit me a few weeks ago and it is healing so slowly.” “How long ago was the bite?” I asked. “Eight weeks ago, he said.  I peeled back the bandage. There appeared ugly, two inch long shallow ulceration where the bandage had been. That began the following conversational volley: “Are you diabetic? “I asked. “No.” “Do you have heart disease?” I continued. “Had a heart attack 6 years ago. Dr. Smith put in two stents.” “Are you a smoker or a former smoker?” “Thirty-five years. Quit in 2000.” He said. “Do you ever get pain in your legs when you walk?” “Yeah, and you know what? I used to be able to walk the whole course. But now I have to take the cart, and even then, by the time I get to the third hole, my legs are killing me!” “Do your legs feel better when you sit back in the golf cart?” “Yes.” “Do you ever have to sit up in a chair to sleep at night, because your legs start to ache when you lie down.” “Yes! Gosh, Doc, how do you know this?” “One last question” I said. To those of you who know me from my clinic, and know I am originally from New England, you will understand. “One last question, just to make sure I don’t miss the diagnosis. Are you a Jets fan?” We both laughed!! My AFC East rival and new friend manifested what is a classic case of Peripheral Arterial Disease, or PAD.   PAD occurs when atherosclerosis develops in arteries, causing them to be unable to deliver an adequate supply of oxygenated blood to muscles of the legs. Almost all of us have it to some degree, and nearly half of us will never feel any symptoms from it. However, that means almost half of us are at risk for having symptoms. Some symptoms include pain with exertion, which gets better with rest. This is called claudication. Another symptom is vague pain in the legs that you may think is from something else, like diabetes or neuropathy. Still another way PAD can manifest is pain in the legs while at rest. PAD can also present, as with my patient, as a skin wound or ulcer that does not seem to heal well.   Who is at risk for develop symptomatic PAD? Anyone over the age 70 is at risk, as well as anyone over age 50 with a personal health history that includes smoking or diabetes or both.   If you have a personal history of heart disease or ischemic stroke, chances are that you also have PAD and are at risk for becoming symptomatic.   How is PAD diagnosed? In the office, your doctor can do a screening test called an ankle-brachial index. If that screening test is abnormal, your doctor can send you to a Vascular specialist for further evaluation and treatment options.   How can you prevent PAD from developing or becoming symptomatic? First, if you smoke – STOP! Second, if you have high blood pressure, do what you can to keep it well controlled. Third, get your cholesterol to goal, by diet, with medication or a combination of both. Fourth, if you have diabetes, do your best to achieve optimal blood sugar control. Fifth, keep moving! Exercise will increase blood flow to those hurting muscles, and over time, will reduce that pain you may feel as a result of PAD. Beyond that, your doctor may recommend you take an antiplatelet agent such as aspirin or Plavix. In advanced cases, a Vascular specialist may recommend surgical intervention to restore blood flow to oxygen deprived tissues in your legs.   Remember, with PAD and most any other ailment, take control of your healthy lifestyle and live well!