If you feel pain in your legs after walking only a block or two, it may be due to peripheral vascular disease, an ailment that hospitalises nearly 13,000 Australians a year. Surprisingly, more exercise is part of the treatment-and it can bring real relief.
Peripheral vascular disease (PVD) occurs when the arteries in the 'periphery' of your body--typically your legs--become narrowed or blocked by the build-up of a fatty substance called plaque. The blockage usually develops over many years because of atherosclerosis (also known as hardening of the arteries), the same problem that gives rise to coronary heart disease, heart attack and stroke. The risk factors for all these illnesses are similar: specifically smoking, high blood pressure, high cholesterol, diabetes and a sedentary lifestyle.
When blockages occur in your leg arteries, not enough oxygen-rich blood can get through the vessels to replenish your muscles. The resulting pain when you walk, which is relieved when you stop, is termed intermittent claudication. An MRI will probably show blockages within your arteries. As the blockages progressively worsen, you may feel pain after walking only a short distance or even when you're at rest. Your feet may develop sores and tissue may then die off, a dangerous condition called gangrene.
LIKELY FIRST STEPS
The good news is that virtually no-one ever dies from peripheral vascular disease. The bad news is that the condition will deteriorate unless you make some significant lifestyle changes. The aim of therapy is to relieve pain and over the long term, to prevent your condition from becoming worse. Regular exercise, a healthy diet and weight maintenance can go a long way towards helping you achieve these goals and will also lessen your likelihood of having a heart attack or stroke. Medications and surgery can also help.
Lifestyle changes
In milder cases of PVD, an exercise program can dramatically relieve leg pain and prove to be as effective as medications or surgery for increasing the distance you can walk without pain. When you exercise regularly, the body naturally uses smaller blood vessels. With PVD, this added circulation will help compensate for a blocked artery. You'll need to push yourself a bit by walking every day. Pick a realistic distance, say 400 metres. Then walk until you feel pain. Stop and rest, checking how far you you've come and how long it took. When the pain passes, start walking pain. Keep up this cycle for the full distance. In a few weeks, your 'points of pain' will improve and you can start increasing both your daily distance and your speed.
Treatment Options
LIFESTYLE CHANGES
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Exercise Can be as effective as drugs or surgery.
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Stop making Key change to help your circulation.
----------------------------------------------------------------------------------------------------------------------------------------------
Healthy diet Fruit, vegetables and no saturated fats.
----------------------------------------------------------------------------------------------------------------------------------------------
Treat related conditions Usually diabetes, cholesterol, hypertension.
MEDICATIONS
----------------------------------------------------------------------------------------------------------------------------------------
Circulation-Improving- Aspirin, Plavix, Ticlid, Iscover.
-----------------------------------------------------------------------------------------------------------------------------------------
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Angioplasty Compresses plaque to clear vessel.
---------------------------------------------------------------------------------------------------------------------------------------------
Bypass surgery Reroutes blood around clogged artery.
TAKING CONTROL
Medications
Your doctor may prescribe various drugs to improve blood circulation, ease pain and prevent heart attack and stroke, and may also suggest a daily aspirin, which keeps blood from becoming too sticky. Other drugs with similar effects may also be prescribed, such as clopidogrel (Plavix) or ticlopidine (Ticlid). Because peripheral vascular disease is usually a consequence of widespread vascular disease, your doctor will check important risk factors such as cholesterol and blood pressure. If any abnormalites are found you will most likely be prescribed medication to stop the vessel disease worsening.
Procedures
If pain persists, your doctor may try a procedure called angioplasty (see on previous). A thin tube called a catheter is threaded into the problem artery; the doctor then inflates a balloon to compress the blockage and reopen the clogged vessel. A metal device, a stent, may also be used to help keep the artery propped open but in about half of those who have angioplasty, the artery closes up again after several months. Doctors are investigating related techniques such as atherectomy in which a small tool shaves away plaque build-up, but similar problems can occur. If the disease becomes severe, bypass surgery is an effective option (see illustration opposite). More than 75 percent of patients who undergo it are fine five years later.
What is happening
Peripheral vascular disease (PVD) occurs when the arteries in the 'periphery' of your body--typically your legs--become narrowed or blocked by the build-up of a fatty substance called plaque. The blockage usually develops over many years because of atherosclerosis (also known as hardening of the arteries), the same problem that gives rise to coronary heart disease, heart attack and stroke. The risk factors for all these illnesses are similar: specifically smoking, high blood pressure, high cholesterol, diabetes and a sedentary lifestyle.
When blockages occur in your leg arteries, not enough oxygen-rich blood can get through the vessels to replenish your muscles. The resulting pain when you walk, which is relieved when you stop, is termed intermittent claudication. An MRI will probably show blockages within your arteries. As the blockages progressively worsen, you may feel pain after walking only a short distance or even when you're at rest. Your feet may develop sores and tissue may then die off, a dangerous condition called gangrene.
- Daily exercise to build endurance and blood flow.
- Lifestyle changes--stop smoking, lose weight and follow a heart-healthy diet.
- Aspirin or prescription medications for circulation.
QUESTIONS TO ASK
- Should I get a treadmill to exercise at home?
- What if my legs hurt even when I'm not walking?
- How likely am I to develop a more serious problem?
Treatments
The good news is that virtually no-one ever dies from peripheral vascular disease. The bad news is that the condition will deteriorate unless you make some significant lifestyle changes. The aim of therapy is to relieve pain and over the long term, to prevent your condition from becoming worse. Regular exercise, a healthy diet and weight maintenance can go a long way towards helping you achieve these goals and will also lessen your likelihood of having a heart attack or stroke. Medications and surgery can also help.
Lifestyle changes
In milder cases of PVD, an exercise program can dramatically relieve leg pain and prove to be as effective as medications or surgery for increasing the distance you can walk without pain. When you exercise regularly, the body naturally uses smaller blood vessels. With PVD, this added circulation will help compensate for a blocked artery. You'll need to push yourself a bit by walking every day. Pick a realistic distance, say 400 metres. Then walk until you feel pain. Stop and rest, checking how far you you've come and how long it took. When the pain passes, start walking pain. Keep up this cycle for the full distance. In a few weeks, your 'points of pain' will improve and you can start increasing both your daily distance and your speed.
Treatment Options
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Exercise Can be as effective as drugs or surgery.
----------------------------------------------------------------------------------------------------------------------------------------------
Stop making Key change to help your circulation.
----------------------------------------------------------------------------------------------------------------------------------------------
Healthy diet Fruit, vegetables and no saturated fats.
----------------------------------------------------------------------------------------------------------------------------------------------
Treat related conditions Usually diabetes, cholesterol, hypertension.
MEDICATIONS
----------------------------------------------------------------------------------------------------------------------------------------
Circulation-Improving- Aspirin, Plavix, Ticlid, Iscover.
-----------------------------------------------------------------------------------------------------------------------------------------
PROCEDURES
---------------------------------------------------------------------------------------------------------------------------------------------
Angioplasty Compresses plaque to clear vessel.
---------------------------------------------------------------------------------------------------------------------------------------------
Bypass surgery Reroutes blood around clogged artery.
TAKING CONTROL
- Find a podiatrist, a foot-care specialist to help prevent PVD-related infections. Inspect your feet daily for cracks, sores or calluses. If an infection develops, a prescription antibiotic ointment called mupirocin (Bactroban) may help. Take note: if left untreated an infection cna lead to gangrene, which is a serious complication that may require amputation.
- Consider natural therapies. In some European countries, the herb ginkgo biloba (120 mg daily) is medically approved for 'circulatory disorders' like claudication. Vitamin E (400 IU a day) and the amino acid arginine (1000 mg twice a day) may also promote blood vessel health. But let your doctor know of any remedies you are taking; Some can interfere with medications or surgery.
- If pains keeps you up at night, elevate the head of the bed 10-15 cm to increase blood flow to the legs.
- If pain is sudden and severe or the leg becomes cold or blue, seek help immediately. It could be a blood clot requiring an injection of a clot-dissolving drug.
Medications
Your doctor may prescribe various drugs to improve blood circulation, ease pain and prevent heart attack and stroke, and may also suggest a daily aspirin, which keeps blood from becoming too sticky. Other drugs with similar effects may also be prescribed, such as clopidogrel (Plavix) or ticlopidine (Ticlid). Because peripheral vascular disease is usually a consequence of widespread vascular disease, your doctor will check important risk factors such as cholesterol and blood pressure. If any abnormalites are found you will most likely be prescribed medication to stop the vessel disease worsening.
Procedures
If pain persists, your doctor may try a procedure called angioplasty (see on previous). A thin tube called a catheter is threaded into the problem artery; the doctor then inflates a balloon to compress the blockage and reopen the clogged vessel. A metal device, a stent, may also be used to help keep the artery propped open but in about half of those who have angioplasty, the artery closes up again after several months. Doctors are investigating related techniques such as atherectomy in which a small tool shaves away plaque build-up, but similar problems can occur. If the disease becomes severe, bypass surgery is an effective option (see illustration opposite). More than 75 percent of patients who undergo it are fine five years later.
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