By Barbara Meyer
Go Red for Women is honored to have Dr. Nezar Falluji, MD as a speaker at their November 14th Luncheon. During the breakout sessions, Dr. Falluji will be sharing his expertise on peripheral arterial disease (P.A.D.), a condition that affects 8-12 million people in the U.S., 12-20% of individuals 60 and older.
Have you been decreasing the nightly walks you’ve always enjoyed due to pesky leg cramps? Do small cuts and sores take forever to heal? Do your feet always feel cold? What you might associate with “bad circulation” may actually be symptoms of P.A.D.
P.A.D. can lead to very serious consequences if allowed to continue, such as non-healing wounds, gangrene and amputation. Furthermore, patients with P.A.D are at risk for strokes and heart attacks and therefore early recognition and modification of the disease process is crucial to prevent those complications.
What is P.A.D.?
P.A.D. is the narrowing or blockage of the inner walls of the arteries that carry oxygen-rich blood to the various organs and tissues of the body. P.A.D. usually develops as a result of atherosclerosis, an inflammatory systemic condition that is characterized by chronic plaque deposits that build up inside artery walls. While healthy arteries are flexible, the plaque accumulation makes them thickened and stiff, and will eventually narrow the arteries, compromising the healthy blood flow to the area affected. Without proper blood flow, major organs and limbs may become damaged.
While hardening or narrowing of the arteries is a term that’s commonly known, it’s also common to incorrectly think of it as a natural part of the aging process, instead of a dangerous condition that should be prevented. In the early stages of P.A.D., the symptoms can be subtle and attributed to arthritis or other unspecified muscle pain. “The disease is very insidious and often silent in the early stages,” observes Dr. Falluji. “During that time, lifestyle modifications and risk factors management could lessen the impact of P.A.D.”
As a systemic disease, P.A.D. can manifest itself in various parts of the body. In the lower extremities, the Initial symptoms of P.A.D. are frequently a tight, squeezing pain in the calves, thighs, or buttocks while walking, climbing stairs, or during other forms of exercise, that lessens or stops during rest. Healthy circulation would normally supply enough blood to meet the increased need, but with P.A.D., this is the body’s way of saying that the supply isn’t sufficient. Many wrongly attribute the pain and cramping to arthritis even though it is in their muscles rather than joints, and often diabetics confuse it with neuropathy, a burning or discomfort in the feet.
Signs and symptoms of lower extremities P.A.D. include:
• Exertional cramping or aching in the calves , thighs or buttocks that improves with rest.
• Sores or wounds on the toes, heels or other areas of the feet that don’t heal, or heal very slowly
• A lower temperature in one leg compared to the other
• A pale or bluish color to the skin
• Decreased toenail and hair growth on the legs
• Erectile dysfunction, especially among men diagnosed with diabetes.
Men and women are equally affected by P.A.D. The top risk factors for developing P.A.D. include age, smoking, diabetes, elevated cholesterol levels, high blood pressure, inactivity and obesity. What do they have in common? Except for one, aging, all of the biggest risk factors are controllable … by you. If you suspect that you may have P.A.D., your next step should be to partner with your doctor for testing and then work with them to develop a treatment plan based on your results.
Your P.A.D. assessment will begin with a thorough overall physical examination, where you’ll also discuss your symptoms, other conditions, diet and exercise levels with your doctor. Blood tests and other non-invasive tests can be done right in your doctor’s office as part of a routine exam, and if needed, there are a number of other procedures, like ultrasounds, CT scans and angiograms, that can be performed in order to attain a conclusive result. You may be referred to another physician who focuses on disorders of the blood vessels (vascular specialist) or one who specializes in the heart and circulatory system (cardiologist).
“Smoking is highly addictive, but smoking cessation is the most important thing you can do to help prevent or lessen the effects of P.A.D., says Dr. Falluji. “The good news is that there are various medications and treatment methods to help the determined patient quit smoking. I will also add that tobacco chewing is equally harmful. Smoking is the most aggressive risk factor for lower extremity P.A.D., and increases the risk of P.A.D. by 2-6 times. Smokers will experience symptoms of P.A.D 10 years earlier than in non-smokers.”
Dr. Falluji cites diabetes as the second-biggest risk factor, especially for women. In severe cases, P.A.D. can lead to gangrene and eventual amputation in diabetics. He stresses early evaluation of foot problems, and recommends a podiatric exam every year, which for diabetics is covered by most, if not all, insurances.
Unfortunately, there is no process or treatment that can completely flush out plaque accumulation on artery walls, but medications, lifestyle and dietary changes can help prevent or slow further buildup. Treatment goals will be threefold: to lessen your symptoms so that you can resume regular activities, including increasing your exercise level, to address existing atherosclerosis elsewhere (which may be silent) to prevent strokes and heart attacks, and to modify risk factors to halt the progression of plaque buildup.
Your doctor can advise you on how to gradually increase your exercise level in a way that takes into account the association of exertion and cramping that’s characteristic of P.A.D. You’ll develop a plan of alternating effort and rest so that you can slowly raise the amount of exercise that you can perform without pain. A diet lower in saturated and trans fat can help decrease cholesterol levels, and cholesterol-lowering medications may be prescribed in conjunction with healthier foods to help you maintain lower levels. You may also be prescribed medication to lower blood pressure and to help prevent the blood clotting that can come with P.A.D. In advanced cases, angioplasty, and bypass surgery may be performed to increase blood flow in arteries.
P.A.D.’s symptoms are often silent, but Go Red for Women encourages you not to be. Speak up to loved ones who may be experiencing symptoms of the disease, and speak up to your doctor about changes you may be experiencing in your own body that could be early signs of P.A.D.
Dr. Falluji is a board-certified interventional cardiologist with Kentucky One Health Cardiology Associates in Lexington, KY. He specializes in the management of coronary artery disease, peripheral arterial and venous disorders, and advanced minimally invasive heart valves repair (TAVR and MitraClip). He is the KentuckyOne Health Cardiovascular Service Line Director and a Board member of the
KentuckyOne Medical Group.