Recognizing the early stages of Peripheral Artery Disease can prevent serious damage to your limbs, organs, and brain.
Left untreated, the tissues with poor circulation can become infected or die. This is known as gangrene and will require amputation to prevent the spreading of the infection.
Before focusing on the early stages of Peripheral Artery Disease, take a look at the basics, your risk factors, and potential treatments.
What You Should Know:
Peripheral Artery Disease (PAD) affects almost 9 million Americans age 40 and older.
➡ PAD is a narrowing of the peripheral arteries to the legs, stomach, arms, and head — most commonly in the arteries of the legs.
➡ Like Coronary Artery Disease (CAD), it is caused by hardening of the arteries (atherosclerosis) due to fatty deposits called plaque, which narrows and blocks arteries in some critical regions of your body.
In fact, sometimes PAD is the first warning of atherosclerosis, which puts your entire circulatory system, including your heart and brain at risk.
➡ Fatty deposits, called plaque, also increase the odds of blood clots that block blood supply and cause tissue death or break off and travel to another part of the body.
This is a common cause of heart attack or ischemic stroke when the arteries to your brain become narrowed or blocked, causing severely reduced blood flow.
➡ PAD becomes more common as we age.
➡ People with PAD have a higher risk of coronary artery disease, heart attack or stroke. The sooner it is diagnosed and treated, the better.
Sometimes There Are No Warning Signs
Not everyone with PAD has symptoms. As many as half the patients don’t have obvious symptoms like pain in the calves when walking or standing, which are common.
➡ And as I often mention, patients need to be specific in describing their medical issues to their physicians.
Too often patients describe leg pain as “my legs get tired out.” They don’t mention having pain in their calves or even cramping.
They just know that they can’t do as much as they could maybe a couple of years ago, and they just chalk it up to getting older and learn to live with it.
Unfortunately, this miscommunication often leads to the possibility of “plaque” going undiagnosed.
➡ Most of the time, doctors don’t see the plaque first because patients don’t come in until they have symptoms. Then we do a test.
The sooner you report the specific symptoms and get tested, the easier it will be to slow the progression of PAD, and that’s the key to preventing serious complications.
➡ PAD does not follow a timeline. If you have the risk factors for PAD: diabetes, you smoke, family history, lack of exercise and poor diet, your PAD will progress faster.
Another issue which complicates diagnosis is that PAD doesn’t usually happen by itself.
➡ There are almost always other things in play, such as plaque in the coronary arteries or in the arteries of the neck, or diabetes, a history of smoking or a family history of these complications
Ask Your Doctor: “Can you check the pulses in my feet? I want to make sure I don’t have peripheral artery disease.’”
➡ The classic symptom of PAD is claudication, which is pain or cramping in the calves, or sometimes even in the buttocks, with exertion (like carrying groceries or going upstairs).
➡ The pain gets better when you rest and then comes back when you start exerting yourself again. This is the classic scenario.
The Symptoms of PAD may include:
➡ Muscle cramping, tiredness, or heaviness in the hips, thighs or calves while walking, climbing stairs or exercising
➡ Leg pain that does not go away when you stop exercising
➡ Foot, toe or leg sores or wounds that won’t heal or heal very slowly
➡ Poor nail growth on the toes and decreased hair growth over time on the legs
➡ Toes and feet look pale, discolored or bluish
➡ Gangrene, or dead tissue
➡ A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body
➡ Erectile dysfunction, especially in men with diabetes
But again, many patients with PAD don’t recognize their symptoms for what they are.
They describe them as “leg fatigue” or “decreased walking ability,” even as “arthritis in my legs, back problems of backaches, and my favorite: “just getting old.”
By the time many people actually feel leg pain, it has gone undiagnosed and the disease has gotten worse.
The consequences of untreated PAD, however, can be very serious — including gangrene, and sometimes even amputation, so be conscientious of any symptoms that are either new for you or which you’ve had for a long time, but have not reported to your doctor.
People at higher risk:
➡ Are age 65 or over
➡ Are age 50-64 and have any risk factors for atherosclerosis, such as:
➡ Smoke, or used to
➡ High cholesterol
➡ A family history of PAD
➡ High blood pressure
➡ Are under 50 with diabetes and have one of the other risk factors listed above
➡ Regardless of age, you have been diagnosed with atherosclerosis.
Your age, obesity, having diabetes and smoking increases your risk.
At least 25% of patients who fit that description, statistically have Peripheral Artery Disease…whether they know it or not.
Due to the increased risk for cardiac events like heart attack or stroke, the first order of business is prevention, prevention, prevention.
➡ Your doctor may prescribe low-dose aspirin and a statin medication.
➡ If you’re diabetic, doctors will emphasize the importance of controlling the amount of sugar in your diet.
These are both “evidence-based” therapies that will prevent these complications which could shorten your lives. These are the basics, the foundation.
➡ Next, the doctor will work on helping you regain function.
How?… Exercise – WALK more. If you start having pain, stop and rest, but then go a little farther, push through.
➡ According to the American Heart Association, structured exercise therapy is an important part of care for people with PAD.
Walking and regular leg exercises can ease symptoms and improve walking distance.
➡ This exercise prescription takes into account the fact that walking is uncomfortable.
Structured treadmill exercise programs, whether in supervised exercise therapy or a cardiac rehab program, consist of alternating periods of walking and rest.
➡ With practice, this walking program improves muscle fitness and increases the time you can walk before the discomfort sets in.
➡ Ideally, the training is done for 30 to 45 minutes at least three times a week.
Once the program is completed, it is recommended that people with PAD continue walking exercise on their own.
➡ If you can’t participate in a supervised exercise program, ask your physician to help you plan a community or home-based program best suited to your situation.
➡ Medicare now covers supervised exercise therapy for patients with PAD who experience pain, cramping, or fatigue in the leg muscles when walking or exercising, and that improves or goes away when standing still.
The old saying applies: “Use it or Lose it.” This will require you to start exercising and practice other healthy lifestyle changes, such as quitting smoking or improving your diet.
Will PAD get better?
It’s pretty much like the prognosis for diabetes. Most patients learn to live with it.
You can, however, improve your symptoms, but it will be up to you how long the improvement lasts. You’ll know by asking yourself these questions before your doctor does:
Are you still smoking?
Need Help To QUIT? Go to the Category “Special Reports” on the right-hand sidebar and find our series on helping you quit.
➡ Are you taking all the prescribed medicine on time and correctly?
➡ Are you controlling your diet?
➡ Are you exercising?
➡ Is your blood pressure under control?
The more you know, the more likely you’ll be able to work with your doctor to make an early diagnosis and start treatment.