More than a mobility thief: Leg disease can threaten life and limb | by
As with most victims, Ed Schreiber’s peripheral artery disease snatched his ability to walk pain-free just as his lazy, strolling days of retirement lay ahead. But unlike many patients, the computer-software specialist saw his doctor at the first sign of the disease, boosting his chance of enjoying his golden years, limbs intact. He might say he can thank his lucky toe.
“It started very suddenly as a severe pain in my toe five years ago,” says Schreiber, 70, of Denver. Initial treatment helped for a while, but eventually the pain struck his calf and became disabling. “It’s as if I were crippled,” Schreiber says. “I couldn’t do anything physical anymore, the pain was so severe.”
Recently, Schreiber opted for a minimally-invasive treatment that had him walking pain-free again almost as soon as he left the operating table. And HealthONE doctors want the 8 million and rising number of Americans with the disease to know: PAD is not a normal sign of aging. It’s a life-threatening condition, and the key to a happy ending is early treatment.
Signals of urgency
Like heart disease, PAD (also referred to as PVD, or peripheral vascular disease) results from arteriosclerosis, or hardening and narrowing of the arteries. The difference is where that plaque builds up: in places as far away from the heart and brain as the leg or foot, says Dr. William Grande, an interventional radiologist at The Medical Center of Aurora. As circulation is increasingly cut off, pain and urgency intensify.
“What can happen is you can start to lose tissue,” says Dr. Omar Mubarak, a vascular surgeon with Presbyterian/St. Luke’s Medical Center, who notes the first sign of PAD is generally cramping in the calf when walking. “At those later stages, it’s a lot harder to fix, and you may end up losing toes or a foot.” PAD can also signal heart disease and carotid disease (blockage in the arteries that go to the brain), Mubarak says, placing people at much higher risk for heart attacks and strokes.
Power of change
Incidence of PAD is increasing along with the factors that contribute to it, says Dr. David Porter, Schreiber’s interventional radiologist who practices with Grande at RIA Endovascular in Greenwood Village. And the key is that, other than genetics and age, most of those factors can be controlled, he says.
“A patient who smokes is seven times more likely to have vascular disease,” Porter says. Other factors include obesity, diabetes, high cholesterol and elevated blood pressure, all of which can be controlled through diet, exercise and medications. And exercise can make a big difference with PAD, he says.
“Patients, under supervision, are encouraged to slowly and progressively walk through the pain,” he says. “By increasing the distance, the body will begin repairing itself.” Adds Mubarak: Whether the body does that by building new blood vessels or by boosting oxygen consumption from the cells is not clear. “But you can feasibly alter your condition.”
A minimally-invasive fix
A bypass surgery was once doctor’s only option when conservative management failed, Porter says, referring to a procedure in which surgeons attach a piece of vein or artificial vein to divert blood flow around an obstructed area. “And that involves a substantial recovery period,” he says.
During Schreiber’s interventional outpatient procedure, Porter advanced a catheter through a needle puncture in his groin to the artery to access the obstructed artery. The obstructions were opened with an attached balloon, and stents were inserted to maintain the opening. The procedure lasted less than two hours, and the results were immediate. “I left the hospital, and that same day, I was doing normal walking, even more than I could do before, with no effect whatsoever,” Schreiber says.
However, not all patients are candidates for Schreiber’s treatment, Mubarak says, and a bypass surgery can still be the right answer. “It just depends on the overall situation; everything has its risks and its benefits.”
Schreiber is just happy to be back to walking pain-free and helping his wife of 37 years with the household tasks. “It was an immediate recovery. It’s wonderful.” And as long as he follows doctors’ orders and continues medical monitoring, he should be good to go, Porter says, adding that Schreiber was fortunate to have caught his PAD early. “In fact, one could say he’s lucky it presented itself as a painful big toe.”
Did you know?
PAD cases rose 23.5 percent worldwide in the past decade, according to the August issue of The Lancet. Quitting smoking is critical to recovery, and patients should seek help from their doctors and/or Colorado Quitline at www.coquitline.org or 800-QUIT-NOW (784-8669)
Tags: Presbyterian/Saint Luke's Medical Center, RIA Endovascular, The Medical Center of Aurora
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