Have you ever been bothered by cramps in your legs or buttocks on walking a little distance, on climbing stairs or even after minimal physical activity? Well, so what if you do. Is this not a common ailment? We all experience it sometime or the other in our hectic routine, don’t we? After all it gets relieved by rest and so could be due to fatigue or rather a simple sign of aging.
This reasoning may hold well in some individuals, but could be a matter of concern in others (particularly smokers and diabetics) when the underlying silent disease surfaces. Those simple leg cramps and fatigue that you experience after short walks or mild activity could very well be the beginning of a serious clinical condition that may be slowly affecting the blood vessels in your body and decreasing blood flow to your legs, arms, stomach and kidneys.
The silent killer
Peripheral arterial disease or PAD is a clinical condition that develops due to interference in the normal blood circulation in your body. Although there is a predominant narrowing of the blood vessels to the legs in most of the patients; it can also affect the vessels of the arms, stomach or kidney, and interfere with the oxygen and normal blood supply. Narrowing or obstruction happens when a plaque that is made up of fat, cholesterol, calcium, fibrous tissue and other substances in the blood builds up along the vessel wall. If not treated on time, the condition can progress to cause death of the involved tissue or organ, and result in gangrene of the legs, heart attack or paralysis.
If PAD affects the blood vessels of your leg, you may initially experience painful cramping in your leg, hip, thigh or calf muscles after walking or climbing stairs. This may deteriorate, and you may experience pain in your feet and toes even at rest. Wounds in your leg may get infected and show very slow healing. You may also experience leg numbness or weakness, coldness in the affected foot, difficult to heal sores, change in the color of your legs (blackening of skin), hair loss or slower hair growth on your feet and legs, slower growth of your toenails, shiny skin on your legs, and erectile dysfunction in men.
Claudication knocks first
The hallmark of PAD is claudication. Claudication is a medical term derived from the Latin term ‘claudicare’ that means ‘to limp’. It typically describes pain in the leg, calf, thigh, or hip on walking, running or climbing stairs. The factor that distinguishes it is that it almost always gets relieved by rest.
If you are developing PAD you will have pain in your legs that comes and goes and is called as intermittent claudication. This happens as the narrowing of the artery usually occurs gradually, so the pain is intermittent at first. As the muscle’s demand for blood and oxygen increases during exercise, you experience the pain as the blood supply doesn’t match the demand. On resting the muscle’s need for blood lessens, and the pain goes away. However, if the blockage in your blood vessel is very severe, then you may experience the pain even at rest.
If you are developing peripheral arterial disease, then claudication is the first stage of the condition. Claudication always begins with a feeling of fatigue or heaviness in the legs or buttocks and progresses to significant discomfort during activity. Patients with buttock claudication will frequently stop walking until the pain goes away and is also known as “window shopper’s disease.” Claudication progresses to the second stage of PAD, if narrowing of the bloods vessels deteriorates and is then termed as CLI (chronic limb ischemia) that includes pain even at rest or while seated and has potential to lead to gangrene.
PAD and you
You are at a high risk of developing PAD or claudication, if you are an elderly person with uncontrolled blood sugars, high blood pressure, and high cholesterol levels. It could also develop if you suffer from a condition termed as atherosclerosis (hardened fat deposits lining the walls of blood vessels). However, you may need to be overly cautious if you are a chronic smoker as the risk is increased four times as compared to others. Even your excess weight, sedentary lifestyle with a family history of heart attack, heart disease or stroke increases your risk as far as PAD is concerned.
Your physician needs to evaluate you
Your physician will evaluate you for the complaints of leg pain particularly on walking or exercising that disappears after a few minutes of rest, numbness, tingling, or coldness in the lower legs or feet, sores or infections on your feet or legs that heal slowly. Your physician would also examine your pulses in the blood vessels in your legs or listen to the blood flow with a stethoscope or a small device called Doppler. He might find low or no pulse sounds beyond the level of blockage.
Your physician will then confirm the diagnosis by doing the ankle brachial index (ABI) test. With this test he will compare the blood pressure in your ankle to the blood pressure in your arm. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, it would be suggestive of PAD. Although this may confirm the diagnosis of PAD your physician would further recommend tests to identify the vessel affected and the level of block.
The other tests needed to confirm a diagnosis of PAD are the Doppler study (assessment of pressure in the blood vessels) of the lower limbs, arteriography or x-ray of the limbs after injection of a dye into the blood vessel, computed tomography angiography (CTA)/ magnetic resonance angiography (MRA) to detect blockages within blood vessels, and ultrasound to produce images of the blood vessels on a screen using sound waves.
Don’t lose hope – PAD is treatable
Although PAD is a serious condition, it is treatable if you seek medical advice as early as possible. Your physician will plan out a management plan that will basically attempt to provide relief from pain, and also try to prevent progression of the blood clot.
The most important lifestyle changes needed to be done by you are to quit smoking, maintain a scheduled exercise regimen, and eat a healthy diet low in fat and oils. Medicines prescribed by your doctor will include drugs to prevent clots, lower your blood pressure, lower your levels of cholesterol, and control your blood sugars, drugs for healing of infected or open wounds and to provide pain relief.
Although surgery may not be the first option in the management of the condition, it may become necessary if the block in your vessel is severe enough to cause damage to the tissue. Your surgeon may create a bypass for the blood flow from another vessel or the surgeon may inject drugs/ a balloon into your blood vessel to break the clot.
Get alert!!!
PAD is silent in its initial days, but is capable of fatal complications such as gangrene and need for amputation of the limb, heart attack, and paralysis. Nevertheless, timely intervention can definitely slow or stop disease progress and reduce the risk of complications. So the next time you feel leg pain, numbness or other symptoms that recur and increase in frequency even with minimal physical activity, don’t ignore it as a sign of fatigue and aging. Get alert and seek medical advice as early as possible before it makes you lose a limb.
