What is Peripheral Arterial Disease (P.A.D.)

P.A.D affect 8 to 12 million people in the United States, especially those over age 50. It does not always cause symptoms, so many people may have PAD and not know it. People who do experience symptoms, such as pain, or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.

Risk Factors:
Some conditions and habits raise your chance of developing P.A.D. Your risk increases if you:

• Are over the age of 50
• Smoke or used to smoke
• Have diabetes
• Have high blood pressure
• Have a personal history of vascular disease, heart attack, or stroke
• Are African American

Diagnosis:
Physical Exam – during the physical exam your pulse in both legs and feet will be examined to determine if there is enough blood flowing to these areas as well as the color, temperature, and appearance of your legs and feet and for signs of poor wound healing on the legs and feet. A review of your medical and family history including: your current diet and medications; any symptoms you may be experiencing in your legs while sitting, standing, walking, climbing, or participating in other physical activities; your status as a current or former smoker; presence of diabetes, high blood pressure, high cholesterol and other important factors are all crucial to an accurate diagnosis.

Non-Invasive Vascular Testing:
Ankle-brachial index (ABI) – ABI compares the blood pressure in your ankle with the blood pressure in your arm by using a regular B/P cuff and a special ultrasound device to evaluate blood pressure and flow.

Duplex doppler – this test uses standard ultrasound methods to produce a picture of a blood vessel and surrounding organs. Also, a computer converts the doppler sounds into a graph that gives information about the speed and direction of blood flow through the blood vessel being examined.

Magnetic Resonance Angiogram (MRA) – it is a type of MRI scan that uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body. It can see the blood flow as well as the condition of the blood vessel walls.

CT Angiogram – is an imaging test for various types of heart disease. It relies on a powerful X-ray machine to produce images of your heart and heart vessels. This is used primarily to check for narrowed arteries in your heart that can put you at risk for a heart attack.

Vascular Testing -The “Gold Standard”
Angiography with Contrast
By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your
arteries as it happens. Your doctor is able to trace the flow of the dye using imaging techniques such as X-ray imaging or MRA or CT angiography.

Treatment:
Timely detection and treatment can help reduce your symptoms, improve the quality of your life; help you keep your independence and mobility; and can reduce your risk of heart attack, stroke, leg amputation and even death. There are three main approaches to treating P.A.D.

1. Making lifestyle changes
2. Taking medication
3. In some cases, having a special procedure or surgery

Lifestyle changes:

• Quit smoking – Don’t smoke, and if you do quit!!
• Lower your numbers – Work with your health care provider to correct any high blood pressure, cholesterol and blood glucose levels.
• Follow a health eating plan – Choose foods that are low in saturated fat, transfat, and cholesterol. Be sure to include whole grains, vegetables, and fruits.
• Get moving – Make a commitment to be more physically active, Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.
• Aim for a healthy weight – If you are overweight or obese, work with your health care provider to develop a supervised weight loss plan.

Medication:
In addition to lifestyle changes, your health care provider may prescribe one or more medications. The medications are used to:

• Lower high blood pressure and cholesterol levels and treat diabetes.
• Prevent the formation of blood clots that could cause a heart attack or stroke.
• Help reduce leg pain while walking or climbing stairs.

Special Procedures and Surgeries
If the blood flow in one of your limbs is completely or almost completely blocked, you may benefit from having a procedure of surgery in addition to medications and lifestyle changes. Procedures such as angioplasty and bypass graft surgery will not cure P.A.D., but they can improve the blood circulation to your legs and your ability to walk.

Questions to ask your health care provider:

• Will P.A.D. increase my risk for other conditions?
• Which screening tests or exams are right for me?
• What are my cholesterol numbers? (LDL, HDL, and triglycerides.)
• What is my blood pressure?
• What is my blood sugar level?
• What can I do to quit smoking?

The IAC is comprised of five divisions including Vascular Laboratories, which is dedicated to promoting noninvasive vascular diagnostic testing in the delivery of health care by providing a peer review process of laboratory accreditation. Accreditation is a voluntary process. For more information on accreditation visit: www.icavl.org.

Committed to balancing the changing needs of both the vascular community and the general public, the ICAVL was created in 1990 by uniting physicians, technologists and sonographers from the sponsoring organizations. Collaborating together, those physicians, technologists and sonographers composed the body of work known asThe Standards, an extensive document defining the minimal requirements for vascular laboratories to provide high quality care. Laboratories use The Standards as both a guideline and the foundation to create and achieve realistic quality care goals.

ICAVL Accreditation is offered in the following testing areas:

• Extracranial Cerebrovascular
• Intracranial Cerebrovascular
• Peripheral Arterial
• Peripheral Venous
• Visceral Vascular
• Screening

Dr. Kassouf is accreditated in Extracranial Cerebrovascular, Peripheral Arterial and Peripheral Venous.

Vitamin A
Vitamin A plays a role in several functions throughout the body including vision, immune function, embryonic development and reproduction, bone metabolism, and most important in regards to varicose veins, skin health and antioxidant activity.

Found in orange and dark green fruits/vegetables like carrots, pumpkin, sweet potatoes, winter squashes, cantaloupe, pink grapefruit, apricots, broccoli, spinach, and most dark green, leafy vegetables Vitamin A is actually best absorbed from animal sources like beef, calf, and chicken liver; fish liver oils; whole milk dairy products such as yogurt and cottage cheese; eggs.

A vitamin A intake of 25,000 IU is recommended for skin integrity and in the case of existing varicose veins, can promote the healing of ulcers.

Vitamin C & Flavonoids
Vitamin C and flavonoids has been found to aid circulation, promote healing of sores, and assist in the strengthening of fragile vein walls.

Particularly high levels of vitamin C can be found in broccoli, bell peppers, kale, cauliflower, strawberries, lemons, mustard and turnip greens, brussels sprouts, papaya, chard, cabbage, spinach, kiwifruit, snow peas, cantaloupe, oranges, grapefruit, limes, tomatoes, zucchini, raspberries, asparagus, celery, pineapples, lettuce, watermelon, fennel, peppermint and parsley.

The recommended daily intake is 1,000 mg vitamin C and 500 mg flavonoids 3 times a day. Reduce vitamin C dose if diarrhea develops.

Vitamin E
Vitamin E promotes improved circulation, connective tissue growth and is believed to help relieve calf pain due to narrowing of the arteries (though studies are inconclusive).

Excellent sources of vitamin E can be found in asparagus, avocado, eggs, milk, nuts (such as almonds or hazelnuts), seeds, spinach and other green leafy vegetables, unheated vegetable oils, wheat germ, wholegrain foods such as fortified cereals.

Check with your doctor if taking anticoagulant medications. Dosage recommendations take 300 to 800 IU.

B Vitamins
Vitamin B-complex can help maintain strong blood vessels and has been found to support and increase the rate of metabolism, help maintain healthy skin and muscle tone, enhance immune and nervous system function, and promote cell growth and division—including that of the red blood cells that help prevent anemia.

B vitamins are found in all whole, unprocessed foods such as brown rice, wheat and barley. B vitamins are particularly concentrated in meat and meat products such as liver, turkey, and tuna. Other excellent B vitamin sources include: potatoes, bananas, lentils, chile peppers, tempeh, beans, nutritional yeast, brewer’s yeast, and molasses.

The following steps are not only beneficial for those already suffering from varicose veins but also decrease the likelihood of developing varicose veins in the future.

1. Elevate your feet at least once a day for 15 minutes. When seated at work or home simply put your feet on a elevated surface

2. Avoid tight fitting clothes, non-stretchable fabrics, and clothing that cuts at the waistline as they can restrict blood flow.

Tip: Make sure when wearing suits that pants or skirts do not feel too tight when sitting. Most people try on clothes and make judgments on the fit when they are standing up. Before buying clothes, sit down in them to see how they feel.

3. Avoid standing or sitting for long periods of time. If you have to work on your feet or sit for long periods of time, keep moving, this will help to keep blood flowing throughout the day. Do NOT cross your legs while seated.

4. When sitting, flex your muscles and wiggle your toes to increase blood flow. When standing shift your weight between both legs and stand on your toes occasionally.

5. Avoid the lifting of heavy objects as this can create unnecessary strain.

6. Eat plenty of blackberries and cherries. They are rich in compounds that help prevent varicose veins and can lessen the discomfort attributed to them over time.

7. Apply Castor oil over the varicose veins after bathing. Used for hundreds of years, castor oil helps to relieve pain, increase lymphatic circulation and reduce inflammation.

8. Avoid scratching the itchy skin above varicose veins. Scratching can irritate the thin skin creating ulcerations and bleeding.

9. Wear special elastic compression stockings also referred to as compression hose or compression socks. Compression stocking are a simple, inexpensive way to treat varicose veins. It’s best to consult with a physician on the proper compression level for your condition. These specially fitted hose are designed to reduce the pooling that occurs but won’t eliminate varicose veins.

Doing a few simple exercises along with the tips below may help to decrease the risk of DVT.

• Ankle Circles: Raise your feet off the floor and rotae them in a circular motion. Make five circles in clockwise and counterclockwise directions with each foot.
• Knee-to Chest Stretch: While seated, lean slightly forward and clasp your hands around one knee. Slowly pull your knee toward your chest and hold for 15 seconds. Release and switch to the other leg. Repeat twice.
• Foot Pumps: With your heels on the floor, raise your toes as far as possible. Hold for a few seconds and lower them to the floor. Then raise your heels while keeping our toes on the floor and hold for several seconds. Repeat five times.
• Neck Roll: Relax your shoulders. Stretch your neck toward your left shoulder; hold for a few seconds, slowly roll your head toward your chest, and then stretch toward the right shoulder. Hold for several seconds and then reverse, rolling your head from right to left. Repeat three times.

Long-distance travel, exciting as it may be, can also be tiring following these tips can reduce the stress and fatigue that may occur with long-distance travel and can combat the jet lag that may result from crossing time zones;

• Wear comfortable clothing and shoes.
• Get a good night’s sleep before your trip and rest as much as possible during the flight.
• While away, get as many hours of sleep every day as you would normally at home. Taking short naps of 30 to 40 minutes will help to refresh you as you adjust to the new time zone.
• Drink plenty of water and/or juice before and during the flight to stay hydrated.
• Eat light meals during your flight. Also, avoid caffeinated and alcoholic beverages.
• Don’t remain in one position too long; peform the simple stretches above and walk when possible.

When choosing a physician, it is important to make an informed decision. This involves knowing the qualifications, training, and experience of your physician. With over 25 years of experience, Dr. Michael Kassouf, a board certified surgeon, has been helping those who suffer from varicose and spider veins improve their appearance and regain vitality of their legs.

Although sclerotherapy is a common procedure used in the removal of spider veins, laser treatments are often the most effective way to treat facial spider veins or those spider veins very close to the surface of the skin. The use of a laser allows the selective targeting of the spider vein without damaging the surrounding tissue. The procedure is relatively quick, and no anesthesia is needed. After treatment, the skin can be noticeably more uniform and natural in appearance.

The amount of time varies from fifteen minutes to one hour, depending on the size of the area being treated, as well as the severity of the problem. Usually, more than one treatment may be needed to achieve the desired results.

More information on Laser Treatments for Vein Removal

Not only are varicose veins unsightly, but they can also be very painful. That tired achy feeling can sap energy and keep you from going out and getting exercise. And while are genes dictate our predisposition to varicose veins the following simple exercises can help minimize the development of new varicose veins and alleviate pain from existing ones.

Walking:
The simplest exercise is to walk more. Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Instead of taking the elevator or escalator use the stairs. Even going for a short walk around the block before going to work is enough to vastly improve symptoms.

Pedaling:
Begin lying on the floor, flat on your back. Place your hands out to your sides, if you prefer you can place them beneath your buttocks to prevent strain to the lower back. Lift your legs off the floor, and pedal them as if you were pedaling a bicycle. The more you elevate your legs, the more you will increase blood circulation. Reversely keeping your legs lower will increase resistance on your abdominals, toning your stomach. Continue this exercise until you feel the blood circulating through your legs and any existing pain has begun to abate.

Leg Lifts:
Unlike leg lifts performed at the gym, which are usually designed to tone your inner or outer thighs, these leg lifts are designed to help ameliorate blood flow through the entire leg. Lie on your back, placing your hands beneath your buttocks to eliminate lower back strain. Keeping your buttocks pressed down, and your lower back against the floor, lift one leg at a time and hold in an elevated pose perpendicular to the floor. Hold this pose until you feel the blood begin to flow back up from your feet, your calves, and your thighs. Repeat the motion with your other leg. For ultimate relaxation, lie on the floor with your buttocks almost touching a wall. Rest both your legs in an elevated pose resting against the wall, and feel the circulation in your legs improve. Alternately, you can raise both legs and rotate your ankles to further improve leg circulation.

Knee bends with ankle flexon:
Lie again on the floor on your back. Slowly pull one knee into your chest, holding onto your leg behind your knee (holding on top of the kneecap puts undue pressure on this delicate joint). While your leg is in this position, point and flex your foot several times. Do this slowly and forcefully – don’t let your flap foot around loosely, but rather tighten the muscles of the calves and the tendons around your ankle. Repeat with the opposite leg.

Because varicose veins are caused by genetics, there is no way to completely prevent them. But improving your circulation and muscle tone can reduce your risk of developing varicose veins or getting additional ones. The same measures you can take to treat the discomfort from varicose veins at home can help prevent varicose veins, including:
* Watching your weight
* Eating a high-fiber, low-salt diet
* Avoiding high heels and tight hosiery
* Elevating your legs
* Avoid cross legged sitting
* Changing your sitting or standing position regularly

So was Josephine Donovan, until she learned the startling truth – that a common circulation snafu was to blame for the leaden fatigue she felt constantly. Tiredness so severe that she couldn’t even rally for the New Year’s Eve blowout that her family threw every year. In fact, it was tough just keeping herself awake long enough to watch the ball drop on TV. Here, the discovery that allowed her to regain her vitality and reclaim her life.

As I entered my mid-thirties, and especially after giving birth to my two children I began to experience extreme fatigue, achy legs and memory brownouts. Lab tests came back normal and my symptoms were chalked up, both by doctors and myself, to a full family life and a heavy workload.

But a vicious cycle ensued, in which the more tired and uncomfortable I felt, the more sedentary, withdrawn, frustrated and down on myself I became. It got to the point where my listlessness seemed never ending and I was complaining all the time, especially to my poor husband.

My kids felt it too. I was not the participatory mother I would have liked to have been. More often than I care to admit I’d wave a forlorn good-bye from the couch as my husband took the kids to the mall or roller skating.

Still, even as I grew more and more withdrawn for sheer lack of energy, I figured (and most people I talked to agreed) that it was the norm for a mom who was stretched too thin. And besides, I had another tangible health concern that I felt I could fix, so I focused on that instead.

“I sought professional help, but nothing worked.”
Although I have fairly nice legs, their appearance had always been marred by unattractive bluish and reddish spider veins everywhere. It was so bad that in my twenties (much to my chagrin) I was even dubbed “Spider Woman” by my friends. And the veins had only become more pronounced and painful following my two pregnancies.

I had tried home remedies, including support hose, Epsom salt soaks and vitamin K. In the summer, I resorted to applying thick layers of goopy leg makeup. I even sought out professional cosmetic treatments such as sclerotherapy (injecting a chemical into the vein to close it off). But for every vein that was removed, two new ones would soon crop up.

So I made an appointment with a highly recommended vascular surgeon to see once and for all what could be done for my legs.

“Finally. I knew it wasn’t just ‘Mommy syndrome.’”
I was surprised when the vein specialist asked me not just about my legs but my overall health as well. No doctor had ever discussed my vein problem as anything other than a cosmetic concern. He explained that varicose veins were the most common symptom of a condition called chronic venous insufficiency (CVI), which is marked by poor blood flow.

I also learned that, while this condition can exist even without varicose veins, the legs can be dramatically affected because they are so far from the heart, which is responsible for pumping blood throughout the body. I also found out that a lack of sufficient oxygenated blood to the brain could result in fatigue and fuzzy thinking. So I can get my energy back! I thought.

And when the doctor said that genetics, pregnancy and inactivity play a role, a light went of in my head: My mom also had large glue-green veins on her legs and was often too exhausted to participate in much more than the basics of funning the household. Suddenly, all the pieces of my health puzzle seemed to be coming together!

“One positive change led to another!”
The doctor performed a “deep vein” procedure called an endovenous laser ablation, which used a catheter of laser fiber to collapse the problematic veins. Almost immediately, my symptoms – both cosmetic and physical – improved dramatically.

The physician suggested further boosting vascular health by being more active, drinking more water, eating fruits and vegetables and limiting caffeine intake. While I initially balked at any regimen being added to my already busy day, I began to feel so good about my great-looking legs and newfound energy that one positive change led to the next. I started walking, riding my exercise bicycle and participating in my children’s activities.

I also no longer incessantly complain to my husband. I was too busy dancing with him, like we did at our last New Year’s Even party – our biggest and best yet!

Published by First, the magazine for women on the go. Download the article.