My legs hurt! My feet are cold! My ankles are swollen!
Doctor says, "You have poor circulation, part of getting older."
~or~
"You have Peripheral Neuropathy and there's nothing I can do."Don't settle for that!
You might have a vascular disease that needs treated!
Ask your physician about Peripheral Artery Disease (PAD), a narrowing of the blood vessels can limit flow and starve tissues of oxygen, triggering nerve pain!!!
Get tested!
Sore legs can indicate your risk for heart attack, stroke, and amputation!
Caught early, proper treatment of what's called, "Peripheral Artery Disease (PAD)," can save your life & limbs!
Quick Statistics!
Some of these may surprise you, but they're good food for thought.
1 in 3 Diabetics over age 50 has PAD!
More than 50% of American adults have pre-diabetes/diabetes. 1 in 3 American adults are projected to have diabetes by 2050.
1 in 20 people over age 50 has PAD!
No previous diagnosis of having diseases such as Diabetes or heart disease is necessary. But sore legs can indicate heart attack, stroke, & amputation risk.
3 in 5 people who've suffered a heart attack have PAD!
These people may not have any previous diagnoses of having diseases such as Diabetes or heart disease or PAD.
PAD Quick Facts!
DEFINITION
Plaque build-up in the arteries of the peripherals (arms, brain, legs), mainly the legs.
PAD is a chronic illness in which there is currently no cure but long-term management is possible.
SYMPTOMS
- Leg Pain
- Cramping
- Tingling
- Numbness
- Cold Feet
- Less Leg Hair Growth
- Slow Nail Growth
- Non-healing foot/leg ulcers (Advanced Stage)
- Gangrene (Advanced Stage)
RISK FACTORS
- Family History
- Obesity
- Smoking
- High Cholesterol
- Hypertension
- Age - over 50
- Pre-Diabetes, Diabetes
CAUSE
Plaque build-up in the arteries is triggered by a variety of factors. It could be environmental, genetic, or lifestyle. Plaque build-up is generally the body's inflammatory response to "bandaid" artery damage caused by hypertension, stress, diet, smoking, and/or diabetes. Advanced blood work can help get to the root cause.
CURE
PAD does not have a cure. But you can slow disease progression significantly by getting to the root cause of what's damaging your arteries, making critical lifestyle modifications, and timely treatment. Online research will reveal a 5-year mortality for PAD. Early diagnosis and newer interventional approaches have improved the prognosis. Patients are walking 20 years after diagnosis with the right treatment.
EARLY DIAGNOSIS
There are two classifications for PAD: Claudicant and Critical Limb Ischemia, which is advanced stage. If diagnosed in its early stages, PAD can be managed with Pharma, and Lifestyle modifications (Diet, Exercise, etc.). Walking is the best medicine in the early stages because your body may have the ability to re-route blood flow around blockages with a regimented walking program. Advanced stages may require intervention using endovascular (minimally invasive tools and techniques) or invasive procedures such as bypass and amputation. Don't let your doctor brush off leg pain and cramping as old age, poor circulation or neuropathy.
EARLY TREATMENT
Getting a referral to an interventional vascular specialist soonest is critical to begin taking steps to slow disease progression.
Discuss critical pharma, exercise, and diet, and supplement options that will make a big big difference.
Walking is critical to improving symptoms as your body grows collateral vessels to increase blood flow around artery narrowing with every step you take.
Walking a lot can help delay surgical treatment and increase the timespan between follow-up surgical interventions.
SURGICAL INTERVENTION
If caught early, most Interventional Vascular Specialists will tell you to walk until you experience what's called, "Lifestyle Limiting Claudication." Most patients early on can walk a short distance, stop for a few when legs tighten up, and can continue to walk a little more after a 90 second break.
Your Interventional Vascular Specialist will consider an Angiogram, a minimally invasive surgical treatment to improve blood flow when you can no longer maintain an active lifestyle because the pain and cramping is unbearable due to plaque has caused a narrowing and stiffness in your arteries.
Angiograms are typically are outpatient procedures performed under light sedation and take anywhere between one to three hours.
Doctors usually will start with a simple puncture in the groin area and follow with a wire to navigate the vessel. A balloon may follow to lightly push plaque aside but heavy plaque build-up may require what's called an "Atherectomy" device, which physically removes the plaque either with a blade, audiowaves, or laser (Rotational, Orbital, Directional, Audiowave, Laser).
If a doctor is highly skilled in new Interventional techniques for revascularizing arteries, (s)he will be less likely to suggest bypass or amputation.
WHO TREATS PERIPHERAL ARTERY DISEASE
CHOOSING THE RIGHT DOCTOR FOR YOU
This is a life & limb saving decision that should not be taken lightly.
There are three primary practices which treat Peripheral Artery Disease:
- Interventional Cardiologist
- Interventional Radiologist
- Vascular Surgeon
Some overlap in their treatment approach, others do not. Some are highly trained in newer minimally invasive procedures and others are heavily trained in invasive bypass & amputation. Upon referral, most general practitioners don't know the Vascular Specialist's approach for treatment.
You must research.
Different doctors have different limitations, whether it's standard protocols, monetary, exclusive vendor relationships for tools, or skillset that may impact your long-term prognosis.
Each one is likely to tell you that if they can't do it, no one else can either and their way is the best way. It may be true. It may not, even at the most prestigious hospitals and with doctors who have the highest pedigree.
But it's not worth taking the chance.
Ask questions about...
- their their standard approach,
- go-to tools,
- their threshold for revascularizing arteries in a minimally invasive way before giving up and choosing bypass or amputation,
- how do they minimize trauma to the vessel to ensure long-term patency,
- whether they are highly trained in revascularizing small vessels below-the-knee,
- and more specifically about their experience in revascularizing the plantar loop especially in Diabetic feet.
Your life and limb depend on it.
SAY NO TO AMPUTATION
Amputation should be a last resort ONLY if ALL minimally invasive treatment options are exhausted yet more than 200,000 PAD related limb amputations are performed every year.
Recent advances in techniques, tools, and approaches now make amputation rarely necessary with the right physician.
In fact, more than 80% of all P.A.D. related limb amputations are preventable with early appropriate diagnosis and treatment.
Ask your physician if he is considered a "CLI Fighter" by his peers who knows how to use wires and balloons clear into the pedal loop of the foot and can offer multiple approaches to tackle a blockage, including coming down from the groin AND coming up from the foot or calf.
GET A SECOND OPINION
If your doctors says bypass or amputation, ask for a second opinion elsewhere outside of the hospital.
EVERY Doctor has different tools, techniques, and approaches. ALWAYS seek multiple opinions to ensure you are getting the best individualized treatment.
ACT NOW
PAD increases risk for heart attack, stroke, amputation. Three in 5 people who have a heart attack, already have plaque build-up in their legs. And as mentioned above, more than 200,000 people have lower limb amputations due to PAD which went untreated.
Say, "Hey Doc, measure the blood flow in my leg arteries to check for artery blockages."
- Do I Have PAD?
Check your symptoms by taking this survey. Bring this survey to your doctor.
Diagnosed with PAD, Now What?
The Global PAD Association is a Supporting Partner in the Get A Pulse On PAD Campaign, which offers this helpful video:
Medical NotePAD
Video series focused on explaining the fundamentals of Peripheral Artery Disease
- Why do most people go undiagnosed with PAD?
Many people brush off symptoms of leg pain or cramping simply as part of aging, poor circulation, or neuropathy. Another misstep occurs when a doctor performs a basic ABI (Ankle-Brachial Index) Test, which measures the blood flow in the leg versus that in the arm, and results are 'normal.' An ABI test may give a false negative result because the vessel may already be calcified. Patients who receive a 'normal' result but still feel leg pain/cramping should follow-up with further testing including a Duplex Ultrasound.
- Diabetes | PAD
Leg Numbness, Tingling, Cramping: PAD or Neuropathy? or Both?
One in three diabetics over age 50 has Peripheral Artery Disease, many don't realize it until non-healing ulcers or gangrene develop. With diabetes, a patient may suffer from a condition called neuropathy. The nerves in the legs and feet are damaged from the consistent high blood sugar levels. So they may feel stinging and sharp pain in those areas, or they may also feel numbness and have issue with having any feeling at all in their legs or feet.
In Peripheral Artery Disease (PAD), the arteries that bring blood to the leg muscles and surrounding tissue is narrowed or blocked by various plaques. This can cause the person to feel pain as well -- which is why your blocked arteries may end up going unnoticed until advanced stages where a non-healing sore (ulcer) develops on your lower leg or foot.
It's important to ALWAYS ask your doctor to measure the blood flow in your legs.
Frequently Asked Questions
What are the two types of P.A.D.?
The two types of P.A.D. are defined by 'claudicant' or 'critical limb ischemia.' The majority of P.A.D. Warriors fall into the claudicant category and never progress to a limb threatening stage of this disease. Walking is the best medicine for most if P.A.D. is diagnosed early and the body has time to develop and re-route blood flow through its collateral network of arteries. Critical limb ischemia(CLI) is an advanced stage of disease which is recognizable by a non-healing wound on your foot or toe, and/or rest pain that wakes you up at night which forces you to dangle your legs over the side of the bed for relief. Patients with CLI must seek treatment by a qualified limb salvage specialist sooner rather than later as time is tissue. For more on the two types of P.A.D., watch this video with Dr. Anahita Dua: https://youtu.be/t4iHD8WWDf0
How do I makes sense of my ABI and Ultrasound results?
To diagnose P.A.D., doctors may order one of two initial tests: 1. Ankle-Brachial Index test which entails placing blood pressure cuffs on your legs and feet, measures the blood pressure in the arms versus the legs to see if you are getting blood flow to your feet; 2. Ultrasound directs high-frequency sound waves to the artery or veins being tested to help physicians understand your circulation. Technician Jill Sommerset explains these two tests in detail as well as how to understand your results: https://youtu.be/FWRS5uk_enw
Should I have a procedure to open up my arteries?
If you have restricted blood flow in your leg arteries due to plaque build-up, known as Peripheral Artery Disease or P.A.D.…
Your doctor may not offer a procedure to mechanically increase flow right away.
Why?
I’m doctor Bradley Hill with Hill Vascular & Vein Center in Campbell, California.
Vascular specialists decide on the best course of action for treating P.A.D. based on symptoms.
If you have a non-healing wound on your foot and/or are experiencing pain and leg cramps that wake you up at night…yes… a vascular specialist will discuss moving forward with an interventional or surgical treatment.
If you have leg pain and leg cramps while walking that are relieved when you are at rest, frontline treatment for that, which they call, “Lifestyle Limiting Claudication” is “Lifestyle Modifications” coupled with medical therapy.
Sometimes a vascular specialist will offer an intervention for lifestyle limiting claudication if you can’t make it to the kitchen or the mailbox without debilitating pain and cramping…
It’s important to have the discussion with your physician about frontline medical therapy such as medications to thin the blood, reduce clotting, and improve cholesterol - coupled with efforts to stop smoking, improve diet, and walk.
Many insurance companies require that for usually a time period of three months anyway to see if symptoms improve are their own… and if symptoms don’t, then it’s important to discuss a minimally invasive intervention or surgical option as the best next logical step in order to improve symptoms.
But walking is most important because it’s the best medicine for P.A.D. no matter what.
Our bodies are amazingly resilient!
Walking triggers a collateral network of vessels that will expand to help re-route flow around artery blockages.
Due to walking, some patients never need any procedure despite artery blockages because their body grows enough collateral vessels to improve symptoms to a point where their lifestyle is not limited by leg pain and leg cramps anymore.
Once you have a procedure, you will need to be on track with lifestyle modifications anyway in order to increase the durability of the procedure.
Why?
Old habits can lead to plaque coming right back!
So, it’s good to become an equal partner in your P.A.D. Care… and get started on what YOU can do on your own to slow the progression of disease…
Versus getting caught in a revolving door of interventional and surgical treatments.
Listen to Dr. Brad Hill explain the above here: https://youtu.be/kRbCWwRnvR8
Why am I seeing a Nurse Practitioner instead of my vascular doctor?
Is your vascular center scheduling a consult for you with a nurse practitioner instead of a doctor?
Hi I’m Nurse Practitioner Kay Smith with more than 40 years of experience in vascular health.
Let’s talk about why your vascular may schedule you for a consult with a nurse practitioner versus a doctor.
It’s an important discussion because it’s happening more often these days…with many areas experiencing physician shortages.
And you need to know that you aren’t sacrificing the quality of care having a nurse practitioner versus a doctor.
In fact, with so many patients who have peripheral artery disease, or P.A.D., which is restricted blood flow in the leg arteries, who are concerned they don’t get enough education about the disease from their doctor…
A Nurse Practitioner will be a breath of fresh air!
Disease prevention and health education are engrained in our training, and it really enhances our clinical interaction with patients.
So, we are likely to spend more time with you.
A nurse practitioner does have more training than a nurse but less training than a doctor.
A nurse Practitioner is qualified to diagnose and treat acute conditions
We can order diagnostic tests such as xrays, lab work, CT scans, and even an angiogram
We can write prescriptions under the supervision of a physician.
Some even serve as a primary care provider and manage a patient’s overall care.
Nurse practitioners can even get board certified for a specialty such as vascular health.
And some specialty clinics train us to take on additional responsibilities support a physician…
Which you may experience in a vascular facility.
At times we are the only ones you see for consult to schedule an angiogram as the clinic physician may spend most of his or her time performing limb saving procedures.
They may also be the attending clinician for your follow-up consult post procedure.
What are the limitations of a Nurse Practitioner?
We can’t perform your surgery - And we must always be under the supervision of a physician.
While a Nurse Practitioner can do a lot, we still are not trained doctors.
So when it comes to vascular, it’s critical for you to understand what you need to ask to determine if a Nurse Practitioner is right for you or whether you need to request a consult with the physician.
Always ask for a physician consult if you ever have a question or concern.
You should never think twice. It’s your life and your limb at-stake and you deserve to feel confident in your care.
Here is some critical information you need as a P.A.D. patient, that if a Nurse Practitioner can’t provide it to you, then you need to request a follow-up appointment with a physician:
You need a comprehensive explanation of your disease state.
That may include:
What is causing the plaque to build-up in my arteries, and if we don’t know, what tests can you order to help us get to the bottom of it?
Also, where are the blockages and/or narrowing in my vessels as well as the percentage?
You need to have a candid discussion on the short-term and long-term strategy for treatment and management. Ask, can you refer me to a walking program, smoking cessation program, and/or a dietitian?
If the Nurse Practitioner is suggesting the next step as an angiogram or surgery and you won’t see the physician until you are on the table, I would suggest asking about the physician’s approaches, tools, and techniques. A Nurse Practitioner should’ve had a physician review your case prior to scheduling an angiogram and would then be able to discuss the physician’s skillset, initial plan of action, and their success rate in cases that are like yours. If they can’t, request a pre-operative consultation with the physician prior to the angiogram.
How do I get my diagnostic images so I can get a second opinion?
How do you get the best care?
You need to learn to be your own best advocate!
When it comes to Peripheral Artery Disease, the most impactful way you can be your own best advocate... is to start collecting your records. Every conversation... every test... every procedure...you want the doctor's notes AND imaging.
Some of this information may be provided in your provider's app or online portal.
But images, such as with ultrasound and angiography, are not.
You have to request those to be put on a CD.
It doesn't matter whether you have a CD player on your computer or not.
A physician who could provide a timely second opinion will be able to view it on the CD. That's what's important.
You can make the request for a copy of the images and the technician's notes when you sign-in for the imaging sessions.
Some are able to give you a copy right after the session with only a verbal request.
Most require that you make the request in writing by filling out a form and it could take up to a week before you can pick it up or get it delivered.
Sometimes you can even make the written request when you sign-in for the imaging session.
Having all of the important records in your hands, not simply on an app or portal, empowers you with the critical health information you need to get the best care possible across practices and facilities.
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