Issue link: https://viewer.e-digitaledition.com/i/763521
JAMES A.M. SMITH, DO, says PA D a lso can be referred to as atherosclerosis obliterans, which is a fitting description of what the disease does to the arteries of an estimated 18 million su‚erers in the United States. "Atherosclerosis obliterates arteries," says Dr. Smith. "If an artery in the lower extremities begins to narrow or close o‚, it 's the muscle group downstrea m that su‚ers when you use that muscle group." This frequently exhibits itself during active use, and Dr. Smith says patients with PAD complain of achy, fatigued or cramp- ing calf muscles when walking distances or uphill, but a lso note their symptoms alleviate after a few minutes of rest. T h i s d i s c om for t h a s a n enor mou s impact on patients' qua lit y of life a nd overa l l hea lt h, of ten causi ng t hem to g ive up active hobbies, which, in turn, exacerbates the conditions that cause PA D in the first place. " They tend to exercise less so they ga in weight, so their diabetes is worse and this condition progresses," Dr. Smith says, adding that getting the underlying cause addressed can start patients on the road to hea ling. " When there's a wound that won't heal or a wound that is not improving, I think of referring patients to a vascular doctor first rather than to wound care if there's a certain number of risk factors," he says. "If the patient has smoked, has a previous heart stent, or if the patient had a previous stroke or bypass in his or her leg, he or she needs the vascular referra l first." When he receives a referral, Dr. Smith says he does a thorough exam, including ta king o‚ the patient's shoes and socks and listening for arteria l obstructions. "To diagnose PA D, you have to do a good physica l exam," he says. "You listen with your stethoscope in the groin area to the femora l artery (and/or the mid-abdomen for fema les in their 50s with a history of smoking), and a bruit indicates some obstruction of blood flow." The good news is that a number of treat- ment options ca n be deployed once the condition is diagnosed. Fi rst , Dr. Sm it h says, t he goa l is to modify risk factors. T h i s i nc lude s s mok i n g c e s s a t ion , controlling diabetes, combating sitting disease, and integrating regular wa lking or physical activity that works the leg and ca lf muscles. This ultimately ca n help the body develop feeder systems around the blockage. " You don't have to jog. You don't have to buy a treadmill. Just wa lk," Dr. Smith says. " W hatever dista nce you're able to get when the symptoms occur, go a little further and that stimulates feeders, or what we ca ll collatera l blood f low." If this doesn't help resolve PA D symptoms, additiona l out- patient procedure options include utilizing an atherectomy device to clean out the arteries, compressing the plaque with a ba lloon and propping open the artery with a stent. Dr. Smith says with the advancements in the treatment of PAD, 90 percent of these patients can be treated with outpatient procedures rather than an open vascular operation. James A.M. Smith, DO, is a board-certified internist and special- ist in cardiovascular disease who recently was board-certified by the American Board of Vascular Medicine. He trained at the Cleveland Clinic and The University of Pittsburgh. ■ CAN PUT PATIENTS BACK ON THE ROAD TO ACTIVE LIVING BY SARAH GOODING P A D D I A G N O S I S James A.M. Smith, DO ACHY LEGS AND FEET OR SORES THAT WON'T HEAL CAN BE COMMON PROBLEMS FOR PATIENTS WITH A HISTORY OF DIABETES, HIGH CHOLESTEROL, CARDIOVASCUL AR DISEASE OR SMOKING, BUT COULD ALSO BE INDICATIVE OF A COMMON UNDERLYING VASCUL AR CONDITION, PERIPHERAL ARTERY DISEASE ¤PAD¥. 1 3 M D N E W S . C O M /// M D N E W S G R E AT E R K A N S A S ■ D E C 2 016 /J A N 2 017 S P E C I A L F E A T U R E 1 3