Peripheral Artery Disease: An Interview with David Rothman, MD, FACS (Fall 2004)
Optimal health begins with the basic ability of the arteries to deliver life-giving oxygen and nutrition throughout the body. To get the job done, the average adult body has over 60,000 miles of blood vessels. Over time, poor health habits can contribute to the development of peripheral artery disease (PAD). To your health editor, Kathy Lehman, MS, recently interviewed general and vascular surgeon, Dr. David Rothman, about PAD and ways to keep arteries healthy.
Dr. Rothman and ultrasonographer, Cindy Cancelliere, RT, RVT, RDMS,
perform a PAD examination on patient Mary Measel.
Editor: What is Peripheral Artery Disease (PAD)?
Dr. Rothman: Just as the arteries of the heart can become "clogged" due to the build up of fat and cholesterol, the arteries throughout the body can also become narrow or blocked. PAD is often referred to as "hardening of the arteries" and can lead to very serious health problems.
Editor: What causes PAD?
Dr. Rothman: Many of the same lifestyle behaviors that lead to heart disease also contribute to the development of PAD. According to the Vascular Disease Foundation, the single most common cause of PAD is smoking and the risk for developing PAD is as much as three times higher for smokers compared to nonsmokers. Other lifestyle risk factors include a diet high in cholesterol and saturated fat, being overweight and a sedentary lifestyle. Although family history and genetic make-up are risk factors that we can’t control, those who have cardiovascular disease in the family need to be especially vigilant about lifestyle risk factors. Diabetes is yet another complicated factor in the development of PAD.
Editor: What are the warning signs and symptoms?
Dr. Rothman: The most common symptom of PAD is cramping or pain in the muscles of the calves, hips, or thighs during exercise. This pain is different from exercise-related discomfort in that it subsides fairly quickly once the individual stops to rest. Exercise increases the muscle’s demand for oxygen and the pain results from oxygen deprivation in the muscle. The reason the pain subsides with rest is that the muscles are able to "catch up" on oxygen. As PAD worsens, symptoms may include numbness or tingling in the legs, burning or aching pain in the feet, a sore on the leg or foot that won’t heal, cold legs or feet, a color change in legs or feet, and loss of hair on the legs.
Editor: How is PAD diagnosed?
Dr. Rothman: If you have any of the symptoms described above you should discuss them with your primary care physician. He or she may perform an ankle-brachial index (ABI) exam. This exam is one of the most widely used "first step" tests for PAD. It is simple, painless and very reliable. Blood pressure measurements are taken at the arms and ankles using an ultrasound device called a Doppler. Once the measurements are taken, a simple calculation reveals the quality of circulation in the legs.
Editor: What happens after the exam?Dr. Rothman: If ABI results indicate that there is a problem, then the doctor will generally prescribe lifestyle changes and/or medication. He or she may also order additional tests. If the blockage or narrowing is severe, then surgery may be required.
Editor: What are the most effective ways of preventing PAD?
Dr. Rothman: I can’t stress enough the importance of maintaining the health and integrity of the blood vessels. Every cell of the body depends on an adequate oxygen supply and when cells are oxygen-deprived, every part of the body slowly suffers damage. The four most important things you can do to improve circulation are: don’t smoke; eat a healthy, low-fat diet; have regular checkups that include a diabetes screening; and, very importantly, walk, walk, walk.
Editor: What if an individual tries to begin a walking program but can’t walk very far due to pain?
Dr. Rothman: First and foremost, this symptom should be brought to the physician’s attention. The cause of the pain should be explored as conditions other than PAD can cause discomfort while walking. If the doctor gives the go ahead to begin a walking program, the individual should walk only until he or she experiences moderate pain. Then, a few minutes rest should alleviate the pain and the walk can be resumed. With consistency, over time the individual should be able to increase the distance between rests. A regular walking program will stimulate the body to develop new arteries/capillaries. As circulation improves, the pain will diminish. Finally, although walking is a great form of exercise, it’s not for everyone. Exercise such as swimming may be less painful yet still offer excellent health benefits.
Editor’s note: David Rothman, M.D., FACP, specializes in general and vascular surgery. His office is located in the hospital’s Medical Office Building at 647 N. Broad St. Ext., Grove City. The office telephone number is 724-458-5730.
