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Dr Duncan

Peripheral arterial disease

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The anatomists who dissected the human cadavers in days gone by loved their Latin, and gave many of the muscles in our bodies Latin names. One of my favourites is the one for a particularly minuscule muscle in the face. It was given the awesome title of “levator albii superiores et alaeque nasii” and is one of the muscles that makes you smile - literally and physically.

Another Latin term is claudication - from the Latin claudicatio, which means to limp - and this describes a symptom that can occur in those 10 to 15% of Australians who suffer from peripheral arterial disease*, or PAD, a condition primarily found in the legs. Whilst this is sometimes the result of an artery being damaged by trauma, or being squeezed by an aberrant ligament, the most common cause is that due to atherosclerosis.

Peripheral Arterial Disease


Source http://www.drugs.com/health-guide/peripheral-arterial-disease.html
 
As we all know, cholesterol plaques, inflammation and blood clots within the coronary arteries cause heart attacks. But these events can happen in any part of the vascular tree and when it happens to the blood vessels in the legs, one of the diagnostic symptoms is claudication or pain in the calves that makes you to limp after a short period of walking. The pain classically settles on resting but recurs when the muscles runs out of oxygen, and gets grumpy if you decide to walk again.

Typically, this is a disease that affects older people and in particular diabetics.  If the blood supply to the leg is compromised too much, then not only do the muscles start to scream at you, but any tiny cut in the skin can lead to a potentially life-threatening infection. This is because your body’s defense system simply cannot reach the invading bacteria to kill it. Failure to arrest such an infection can lead to gangrene and amputation of the affected limb: and this is at a time in life, for most patients, when mobility is getting more difficult anyway. The usual outcome is loss of independence and your final years confined to a nursing home.
Peripheral arterial disease is a serious problem, and yet is one that can be made less serious if steps were taken to reduce its impact in the years earlier - and that means healthy lifestyle options in your 20s and 30s, 40s and 50s. 
The known risk factors for PAD are:
 Diabetes
 Smoking
 High Blood pressure
 Obesity
 Family History
 High Cholesterol
... exactly the same ones associated with coronary heart disease.

So naturally the things we can do to reduce the risk and threat of PAD are:
 Never smoke or stop smoking NOW
 Exercise 5 times a week for at least 30 minutes. Slowly build up over a few months until the level of exercise is moderate to vigorous and if you’re unsure  what is best for you then ask your Doctor to refer you to an accredited program provider.
 Eat healthily: low fat, fruits, nuts and veggies. And if you have a high Cholesterol then take prescription medication to lower it.
 Blood pressure must be below 140/80 but under 130/80 if you have diabetes.
Complimentary medicines have not been found to have any useful impact on PAD.

Complications:
As well as the muscles causing cramps when exercising, some patients with extensive disease will also get “rest pain” in bed at night. This is usually a sign that a specialist assessment and advice is needed. The other warning sign is trauma to the skin of the lower limb which is failing to heal correctly, as this will often lead to a localized, penetrating ulcer. 

Blockages in the arteries can lead to more serious symptoms such as wounds or ulcers in the legs and feet that don't heal, and in the most advanced stages, gangrene.

Source http://www.columbiasurgery.org/news/healthpoints/2011_fall/p2.html

These ulcers are more common at sites where the skin has bone underneath such as over the ankles and the bunion bones - in other words sites with maximum friction. If left unattended,  gangrene can set in and threaten the viability of the whole limb. All these ulcers must be treated urgently and treated correctly. Well meaning home treatments can lead to disaster, so always seek professional help early.

If you do have claudication, or have a lower limb ulcer that is not healing then there are things that can be done. Your doctor will assess the blood supply to both legs and check the blood pressure in your arms and at your ankles too to assess for any dramatic drop off between the two. You will almost certainly be sent for a Doppler ultrasound test to check the blood flow in the leg arteries. This gives a good guide as to the seriousness of the problem. If appropriate you will then be referred to a specialist who deals with PAD.

Treatment can be surgical, but the lifestyle changes mentioned above are essential to the ongoing success of any treatment program. So you will have to exercise, take medications to lower your blood pressure and cholesterol, and an anticoagulant such as Aspirin too.

Where indicated, any serious narrowing can be stented - just as they are with coronary artery disease: and they can also be by-passed too. But surgical intervention does carry some risks and so prevention is vitally important.

Senior Man Walking On Beach

Source http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/What-is-Peripheral-Artery-Disease-PAD_UCM_430943_Article.jsp

PAD affects, and will continue to affect, millions of Australians and yet we can do so much to reduce its potentially deadly impact. One of them is plain old walking. Walking is great for just about everything, but it’s far easier to do on two legs!

Article written by Dr. Duncan Jefferson. More articles here. For more information on health care and private health cover, visit HBF Insurance at www.hbf.com.au.

The content of these articles is not tailored for any particular individual's circumstances. The author does not take into account your physical condition, medical history or any medication you may be taking. Any advice or information provided by the author cannot replace the advice of your health care professional. The views expressed in this article are those of the author and do not represent those of HBF unless clearly indicated.

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