NORMAL, IL (AP) - The last time you went to the mall, did you have to stop walking and rest from time to time because of pain in your leg or legs? "I see people doing that and they think they're just getting old," observed Dr. Les Ray, an interventional radiologist with Bloomington Radiology in Normal. So they don't tell their doctor.
But painful cramping in the leg or hip while walking isn't a normal part of aging, Ray said.
"It could be PVD," he said. And you don't have to sit still for it.
PVD is peripheral vascular disease, in which arteries that carry blood to the legs and arms become narrowed because of plaque buildup. Reasons may include genetics, poor diet and lack of exercise. People with diabetes, high blood pressure and high cholesterol are more prone to PVD.
When arteries narrow, less oxygen-carrying blood gets to the extremities. That makes the feet or legs numb and susceptible to pain.
"The feet and hands are at the end of the line," said Pat Hudson, a certified wound care nurse. They need blood flow to keep healthy.
To help people understand peripheral vascular disease, Hudson sometimes calls it "a heart attack in your feet."
With blocked arteries slowing blood flow, sores don't heel.
That generally is what brings people in to see their doctor. When wounds resist healing, area doctors may send patients to BroMenn Regional Medical Center's Wound Healing Center.
"Twenty percent of the wounds we see are because of peripheral vascular disease," said Hudson, the wound center's program director.
When wounds don't respond to treatment, patients are given a screening to determine whether they have PVD.
The 15-minute screening begins with a questionnaire, asking patients about their family health history, lifestyle and symptoms.
Patients are asked to lie down and the blood pressure and pulse in their arms and near their ankles are checked using a blood pressure cuff and an ultrasound stethoscope called a Doppler.
Blood pressure readings are compared to determine how well blood is flowing.
If blood flow in the legs is weak, the doctor discusses the results with the patient and may order further tests.
About one in four people screened are found to be at moderate to high risk for PVD, said Ray, who is on staff both at BroMenn and at OSF St. Joseph Medical Center in Bloomington.
But Ray emphasized that doesn't mean that one in four adults has the disease. People who come in to be screened generally are at higher risk of having PVD.
The scary news is that people with the disease also are at higher risk for heart attack and stroke. Untreated, the disease can lead to gangrene, which could require amputation of a leg or foot, Hudson said.
The good news, Ray and Hudson agreed, is that PVD usually can be treated.
Patients are asked to stop smoking, switch to a low-fat diet and exercise. Some patients require a balloon angioplasty to reopen their clogged artery. Some patients may need surgery to bypass the clogged artery with a vein from another part of the body.
"Every little drop of blood has a lot of oxygen," Ray said. "When we can restore blood flow and the wound starts to heal, that's very rewarding."
One challenge is that some peripheral vascular disease symptoms may be the same symptoms as other diseases. Ray doesn't view that as a problem.
"If they have any signs or symptoms, we want to see them," he said. If doctors, after screening, determine that a patient has a disease other than PVD, the patient is referred to the appropriate specialist.
"That's the goal - to get the patient treated," Ray said.
Hudson pointed out that some people who develop PVD have no painful aches in their legs when the disease is at an early stage.
That's why the American Heart Association recommends that everyone 55 and older be screened for the disease.
"Don't think about it too hard," Ray advised people considering getting the screening. "It could save your life or limb."
Health Editor Paul Swiech is at (309) 829-9411 ext. 275 and at pswiech@pantagraph.com.Peripheral Vascular Disease facts
What it is
Peripheral vascular disease (PVD) is a condition in which arteries that carry blood to the arms and legs become narrowed or clogged, interfering with normal flow of blood. The most common cause is atherosclerosis, formerly called hardening of the arteries. Atherosclerosis is a gradual process in which cholesterol and scar tissue build, forming plaque that clogs blood vessels. In extreme cases, untreated PVD can lead to gangrene and amputation of a leg or foot.
Who has it
About 10 million Americans have the disease. At higher risk are people over 50, smokers, diabetics and people who are overweight, who don't exercise and who have high blood pressure or high cholesterol.
Warning signs
The most common symptom is painful cramping in the leg or hip while walking or exercising - but not when muscles are at rest. This occurs when there isn't enough blood flowing to leg muscles during movement. Other symptoms include numbness, tingling or weakness in the leg; a cooling or color change in the legs or feet, or loss of hair on the legs. In severe cases, patients experience a burning or aching pain in the feet or toes, or may develop a sore on the leg or foot that doesn't heal.
PVD can be a warning sign of heart attack, stroke or a life- threatening aneurysm because clogging of arteries in the legs can be a warning of clogging also occurring in vessels from the heart and brain.
Testing
The most common test for PVD is the ankle-brachial index, a painless exam in which ultrasound measures the ratio of blood pressure in the feet and arms. Based on those results - as well as symptoms and risk factors - your doctor decides if further tests are needed.
Treatment
Lifestyle changes - such as stopping smoking, switching to a low- fat diet and an exercise program - may be enough to halt the progression of the disease. Your doctor may prescribe medicine to lower your cholesterol or control high blood pressure. A foot-care program and referral to a podiatrist may be made.
If that's not enough, a doctor may open blocked blood vessels and restore blood flow. An angioplasty involves inflating a special balloon at the blockage site to open the vessel. In some cases, a stent, or cylinder, is placed there to hold the vessel open. Sometimes, clot-busting drugs are delivered to the site of the blockage.
A surgeon may graft a vein from another part of the body to bypass the clogged artery.
SOURCE: Society of Cardiovascular & Interventional Radiology
