PAD (peripheral arterial disease) also called peripheral vascular disease is caused when fatty deposits called atheroma build-up in the arteries. This is a common disease but often ignored.
Who are at high risk?
Men are more likely to develop PAD symptoms than women are and the incidences increases with age – 19% of those over 70 can develop PAD. The most significant risk factor in developing PAD is smoking. Other risks include those who suffer from diabetes, high blood pressure and high cholesterol levels.
Symptoms of PAD
Intermittent Claudation: This is the most common PAD symptom and it is caused when climbing stairs or walking. The pain is normally located in the calf muscles but can radiate to the thigh and hip muscles. The pain can be moderate to severe. It usually lasts for 5-10 minutes and goes when the legs are rested. These PAD symptoms are called ‘intermittent claudation’ (meaning ‘limping’). Other symptoms of claudation include fatigue and a weak or numb feeling in the legs.
Wounds: Patients with PAD develop injuries to the limbs. They can have ulcers (that are open sores) on the legs and feet, black in color, that do not heal. Those with diabetes and PAD are more at risk. Some patients can develop gangrene – a dangerous symptom that causes tissue death.
Cold Feeling: Patients experience coldness in either one or both feet or in the lower legs. They will notice the difference when they contrast the temperature with the unaffected foot or the upper body.
Erectile dysfunction: Men with PAD experience sexual problems such as erectile dysfunction during intercourse.
Other changes: Patients can experience changes in the skin coloration or hair growth on the legs. Some can have hair loss in the feet and legs, slow-growing and brittle nails or shiny skin. Others will find that their skin on the legs turns bluish, pale, or red.
Other symptoms: Apart from the above symptoms, patients with PAD experience shrinking (withering) muscles on the legs or inability to feel the pulse in the legs or pulse feeling weaker than normal.
What to do?
Many people dismiss recurring leg pain as a sign of growing older. This is not true, especially if you are still quite young. Hence, if you do experience such pain or suffer from high cholesterol, diabetes or high blood pressure, fix an appointment with your doctor for you could be suffering from PAD.
Urgent attention is required when blood supply to the legs gets restricted and you suffer from prickling or burning sensation; inability to move the leg muscles; toes turn blue; or the skin on the lower limbs and toes beings to swell, turn reddish, cold and numb and you experience severe pain.
Treatment of PAD
Doctors first conduct an external examination of the patient. This includes looking for PAD signs like hair loss, shiny skin, brittle toe nails and checking the pulse on the legs.
Once this is done, am ankle brachial pressure index (ABPI) will be done. This is the most common test to diagnose PAD. The results of the test indicate how far PAD symptoms have progressed. E.g. a figure of < 0.2 indicates the foot tissues have become gangrenous and require amputation. If there is uncertainty about the ABPI readings and if the patient does not have any other signs – e.g. non-smoker, then doctors will conduct further tests to confirm existence of PAD, like an ultrasound and angiogram. An ultrasound indicates any arteries in the legs that are blocked. In an angiogram, a dye is first injected and then a CT scan or MRI taken.
All patients who suffer from PAD symptoms are first told to introduce aggressive lifestyle changes. These include quitting smoking with the proper aids, control of diabetes, hypertension and high cholesterol. At least 35-50 minutes of exercise 3-4 times a week will be recommended. The exercise should be some form of track walking or treadmill exercise. The pattern ought to be an exercise-rest-exercise pattern that is usually not followed. This reduces symptoms of PAD and improves overall health.
Patients must always keep legs lower than their heart levels and sleep with the bed elevated around 4-6 inches. The latter improves blood supply to the feet. Patients also need to avoid medication like pseudo-ephedrine (cold and cough remedies) that causes vasoconstriction.
Patients will be advised to eat a heart-healthy diet that is low in saturated fats. This controls cholesterol and blood pressure levels that contribute to PAD. Some foods that are high in saturated fats are cakes, biscuits, sausages, bacon, processed meat, cream and butter.
Patients with diabetes, cholesterol and hypertension need to take medications to control these conditions. Other drugs can be given like phosphodiesterase inhibitors to help patients walk distances and medications to prevent blood clots.
In extreme cases, surgery may be performed to open blood vessels that are blocked.
PAD : Prevention and Precaution
Apart from exercise, proper rest and a healthy diet, daily preventive foot care is needed for those with both PAD and diabetes. This includes inspecting the feet daily for lesions and injuries; getting a podiatrist to treat corns and calluses; washing feet daily with lukewarm water and a mild soap and drying them thoroughly; and wearing the right footwear to avoid chemical, mechanical and thermal injuries.
The prognosis for PAD depends on the willingness of patients to make changes in their lifestyle and continue with it. If this is achieved, patients with PAD can have a good prognosis. The outlook is not as favorable when the patient does not make these changes. Then the changes of PAD symptoms worsening, patients developing strokes, non-fatal heart attacks, gangrene that requires amputation increases. There is a one-in-three chance that the patient can die.
Hence, adopt these lifestyle changes, rid yourself of PAD symptoms and live a healthy life.