Newspaper Page Text
PAGE 14, DECEMBER 15, 2008, THE ISLANDER
(News to Q-CeCv
The Best is Yet to Be
By Clark Gillespie M.D.,
Professor Emeritus, the University of Arkansas
PAD
Although not high upon our medical
attack list, Peripheral Arterial Disease
(PAD) is a relatively common and seri
ous senior disease, involving at least 8
million of us - and growing. We need
to knock it up several notches in our
understanding and in our control port
folio.
The PAD plight comes to us cour
tesy of our lifestyle disposition towards
the establishment and extension of
generalized atherosclerotic disease-
the same arterial plaque strangulation
that causes heart attacks and so much
more.
That such arterial damage might
be solely confined to the peripheral
arteries - particularly the legs - would
be very unusual, and if so, primary
PAD symptoms might be regarded as
a lucky warning and, as well, an abso
lute order to institute systemic arterial
studies - particularly in the heart.
Most often, however, this favorable
order and progression of atherosscle-
rotic events is not the usual itinerary,
and by the time we get symptomatic
PAD, we already are suffering a broken
heart.
The major symptom of PAD is pain
ful leg cramps that develop on exertion
- walking. This happens because the
arterial plaques prevent sufficient oxy
gen from reaching leg muscles during
exercise. They act like the large re-sup-
ply carts in your supermarket aisles
- little gets by them easily.
This leg pain is called intermittent
claudication and usually subsides with
rest but in advanced arterial blockage,
may take a very long time to do so.
Other signs of this disorder include
numb, cold or weak legs, change in skin
color, slow healing of local sores and
wounds, and loss of leg hair.
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The risk factors for developing this
extremity disorder are the same as for
atherosclerosis in any of our arteries,
and include smoking, diabetes, high
blood pressure, high blood lipids (cho
lesterol and others), a familial ten
dency, and just getting older - men
65, and women 70 and better are at
greater risk.
The diagnosis of PAD comes from a
recitation of the symptoms to our care
giver followed by a physical examina
tion of the extremities and their blood
vessels. Such an examination reveals
the skin changes described above and
the examiner can often hear - with
a stethoscope - the blood whooshing
through distorted artery linings.
Most importantly, blood pressure
readings from the lower leg area will
be less - sometimes very much less
- than a reading taken from our usual
arm source. This blood pressure test is
called the Ankle-Brachial Index and
should be routinely performed in our
senior population where, as we have
seen, PAD comes home to roost.
More intensive follow-up testing
involves the use of Ultrasound, Mag
netic Resonance or CT scanning proce
dures and more - tests that will firm up
the diagnosis, the disease extent and
the precise location of plaques.
The most invasive diagnostic test
ing involves the insertion of a catheter
into a groin artery, the instillation of a
radio-opaque dye and further precise
location of the blocking plaques. This
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ment of widening arterial stents in
blocked areas.
We must understand that only
advanced stages of PAD are symptom
atic so our healthcare providers must
be prepared to search out the ear
lier symptom-free stages of PAD and
thereby appropriate lifestyle changes
along with corrective medications can
be introduced early-on. We must also
remain aware that the progression of
PAD to its later stages can involve
deadly gangrene in the affected legs,
multiple corrective and by-pass surgi
cal procedures, even the total loss of a
limb, and rarely, life itself.
It is important for us to know and
to remember that PAD is always but
a part of a generalized atherosclerotic
onslaught and requires our very signif
icant lifestyle changes over and above
any local therapy.
Personal and close secondhand
smoking must be totally, absolutely
gone, diabetes -1 or 2 - must be closely
managed, weight controlled and worked
down towards normal BMI standards,
meaningful exercise rigorously main
tained, cholesterol and triglyceride lev
els returned to normal, blood pressure
stabilized at acceptable levels, and our
Mediterranean diet instituted.
Our healthcare providers can assist
us by following and leading our prog
ress at regular visits and by supply
ing appropriate medication therapy to
help our systems and their indicators
return to normal levels. They can also
provide us with further medications to
prevent intravascular clotting when so
indicated.
As a simple and straightforward
example, for most of us, a daily baby
aspirin (81 mgm.) is a helpful and safe
anticoagulant. In case further, deeper
anticoagulation therapy is indicated,
more powerful drugs are available
- drugs that work better but which
require closer monitoring.
When our foot and leg circulations
are clinically compromised, extra foot
hygiene must be maintained. Such
care involves thorough daily foot wash
ing followed by the careful application
of an acceptable moisturizing lotion.
We must wear well-fitting and
appropriate shoes and thick soft socks.
We need to treat infections such as ath
letes foot early and completely. Equally
so, treat any other break in the skin
aggressively.
Unless self secure, an expert should
trim our toenails with great care and
must not trim too short nor too deep on
the sides. We don't ever walk barefoot
- even just to the bathroom at 3:00 am.
Finally, a doctor should see any foot
injury early on.
Just take good care of your feet - you
may never be able to walk on water,
but you want to preserve all your land
walking options until you might get a
chance at the other somewhere much
farther down the line. □
SGHS announces Bath &
Beauty Sale Dec. 18 & 19
The Southeast Georgia Health Sys
tem Brunswick Campus Auxiliary will
host a bath and beauty sale on Thurs
day, Dec. 18, from 7 a.m.— 4 p.m. and
Friday, Dec. 19, from 7 a.m — 3 p.m. in
the Linda S. Pinson Conference Center
on the Brunswick Campus, 2415 Park-
wood Drive, Brunswick.
Proceeds from the sale will benefit
patient care services and equipment.
For more information, call 912-466-
1071 or email kdoll@sghs.org. □
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