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WHAT YOUR LEG PAIN MIGHT BE TELLING YOU

CourierPost article by Dr. Anthony G. Smeglin

It's easy to dismiss troublesome leg pain as a part of the aging process, but leg pain that occurs in the leg muscles should not be ignored. It could be a sign or peripheral artery disease (PAD). PAD is a common blood vessel disease in which narrowed arteries reduce blood flow to your limbs, causing claudication, commonly described as leg pain when walking. PAD affects an estimated 8 to 10 million Americans and is linked to an increased risk for heart attack and stroke.

"Peripheral artery disease is often caused by atherosclerosis, a narrowing of the arteries due to the build-up of fatty deposits called plaque," said Associated Cardiovascular Consultants interventional cardiologist Anthony Smeglin, M.D., R.P.V.I. "The muscles of your extremities, usually your legs, don't receive enough blood flow to keep up with demand, causing claudication symptoms such as pain or cramping in the calf, thigh or buttocks when exerting yourself."

What Does It Feel Like?

Outward symptoms often do not appear until the artery is narrowed by 60 percent or more. The most common initial symptom is calf, thigh or buttock cramping during activity such as walking or climbing stairs. This is called intermittent claudication. The pain or cramping usually gets better after a few minutes of rest. Symptoms can range from mild to debilitating and may lead to tissue breakdown such as an ulcer, and possibly lead to limb loss. The location of symptoms depends on where the artery is clogged.

Some people, however, may not experience any symptoms at all. This usually results from the person doing less and less activity over time to avoid symptoms or from the body's own ability to develop collateral circulation around the narrowed artery.

Additional symptoms include:

  • Foot, toe or leg sores that won't heal
  • A change in the color of the legs
  • An absent or weak pulse in the legs and feet
  • Hair loss on the affected extremity

"If PAD progresses, you may experience pain when you're at rest or lying down," said Dr. Smeglin. "This is not a normal part of aging or arthritis. It should be checked out by a doctor."

Diagnosing PAD

Your doctor may find signs of PAD during a physical exam, such as a weak or absent pulse below a narrowed area of your artery, a bruit or whooshing sound over your artery or poor wound healing.

A relatively quick and inexpensive screening test is called an ankle-brachial index (ABI) is often effective in detecting PAD. It compares the blood pressure in your arms with the blood pressure in your legs. Your doctor may utilize additional non-invasive tests including pulse volume recording (PVR), a Doppler ultrasound or angiography-using a dye injected into your blood vessels and a special x-ray to view blood flow.

Factors that increase your risk of developing PAD include:

  • Smoking
  • Diabetes
  • Being obese
  • High blood pressure
  • High cholesterol
  • Being 50 or older
  • A family history of PAD, heart attack or stroke

Treatment

Initial treatment of PAD includes lifestyle changes to reduce your risk factors. These include quitting smoking, eating a balanced diet that is high in fiber and low in cholesterol, fat and sodium. "Exercise is an important part of any treatment regimen for PAD, as it promotes the development of collateral circulation and cardiovascular well-being," said Dr. Smeglin. Managing other health conditions, such as diabetes, and good foot and skin hygiene (to reduce the risk of complications from non-healing wounds) are important as well.

Medications to lower cholesterol and blood pressure, control blood sugar and prevent clots also may be recommended. "In advanced cases or when exercise and medication fail to relieve symptoms, an invasive procedure may be required," said Dr. Smeglin. "Here at Our Lady of Lourdes, we have assembled a talented team of physicians to treat all manifestations of vascular disease, including endovascular specialists, podiatrists, vascular surgeons and interventional radiologists."

"We may perform angioplasty-threading a catheter to the affected artery, inflating a small balloon to reopen the vessel and then inserting a stent to keep it open. We also may use advanced techniques such as laser or atherectomy to remove the plaque build-up, or special drugs to dissolve a clot. If necessary, we can perform a bypass, allowing blood to flow around the blockage or wound debridement. "If left untreated, patients with PAD can develop serious health problems, including heart attack, stroke, transient ischemic attack (also called a mini-stroke or TIA), and kidney disease or limb amputation.

"PAD can develop over years, and the symptoms may not become apparent until later in life," said Dr. Smeglin. "If you believe you are at risk or are experiencing symptoms, visit a physician."

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