Vascular Disease Foundation - Fighting Vascular Disease... Improving Vascular Health.

Interactive Learning : Ask the Doctor

 

Ask the Doctor Live Chat Transcript - Tuesday, April 7

Marjorie King, MD

Helen Hays Hospital
Member of VDF Board of Directors

 

 

 

 

Moderator- VDF: Thank you for joining us today!  I would like to introduce Dr. King who is now ready to take your questions.


June: Hello! I was wondering if there is a particular type of exercise, other than walking, that I can do for PAD?

Speaker- Dr. King: The best form of exercise to improve blood vessel function of the legs (PAD) is exercise using the legs, especially exercise that is weight bearing, such as walking or using a treadmill. Exercise like bicycling or swimming is good cardiovascular exercise and helps with risk factors for blood vessel disease, but walking helps relieve the symptoms of claudication (leg pain from decreased circulation) since it helps those specific blood vessels and muscles.

June: Thanks so much Dr. King! I'm really going to try to 'step it up'! Also, is there other alternatives to surgery, my doc seems to think I need bi-aorta-femoral surgery, but I really would like an alternative!.

Speaker- Dr. King: June - It's hard to answer without knowing all the facts, but you may want to ask him about stent procedures. I presume you're exercising already, not smoking and taking the medications prescribed. Most doctors do not mind if a patient seeks another opinion and you should consider doing that if you have any doubts about surgery.


Sharon: I have 5% blockage in one leg, vascular disease, I’m 52, going through menopause, can I take hormones?

Speaker- Dr. King: Sharon - A 5% blockage is a very small blockage, since that means 95% of the artery is open. We are beginning to think that it's OK to take hormones for a brief period of time to relieve symptoms of menopause, but if someone has had a recent heart attack or has significant blood vessel disease we do not recommend hormone replacement, even for symptom relief. Using hormones to prevent heart disease doesn't work and can actually cause harm, but it's OK for symptom relief if the risk doesn't out way the benefit. You need to discuss this with your doctors.


Sandy: Walking in the winter has been tough for my mom (she has PAD). Would other things be effective such as toe rises; climbing stairs; swimming, stationary bike?

Speaker- Dr. King: Sandy - As I said earlier, think about weight bearing exercises that use the legs for your mother. She can also look into joining a hospital or physician office based wellness center to use treadmills. Many cardiac rehabilitation programs have those and they're usually self pay, but not extremely expensive. You can go to the AACVPR Web site (www.aacvpr.org ) to look for cardiac rehabilitation programs in your area and call them to see if they know where your mother can go to exercise during the winter.

Sandy: One more question. Would warming the toes (like with an electric blanket) help with circulation when sitting and reading or watching TV?

Speaker- Dr. King: Sandy - Warming the toes may or may not help, depending on whether your small blood vessels are able to open up to bring blood to them. Just be careful to check that you're not burning yourself, since the feeling in your toes may not be as good as it was in the past.


Chai: My and my mother has several vascular issues, a stent in her carotid artery, and recently a DVT in one leg. In reading on the Web I note there are two things that seem the same - PAD and DVT/PE. I know the blood goes one way and then the other and have different effects, but they sound very similar. Is the prevention or treatment radically different?

Speaker- Dr. King: Chai - In the past, we used to think that vascular disease is like plumbing, the blood vessels would just get more blocked with time as deposits of cholesterol and blood clots built up. Now we know that the "clot" that develops in blood vessels is complex and that some "clots" are more organized than others. The lining of blood vessels starts out as smooth, like the inside of your mouth, but when the blood vessel is injured your body tries to heal that injury by bringing in clotting factors, blood cells and other materials to wall off the injury. Sometimes the "clot" is hard and stable, like a scab on your knee. Other times it's soft and easily injured. When it's injured, it heals quickly but the healing process brings in more clot and cells and the blockage gets worse, often quickly. Medications like aspirin and other anti-clotting medicines, cholesterol lowering medicines and blood pressure medicines stabilize the clot and slow down the process. Stopping smoking is the best thing to slow "clot". That's a long-winded answer, but I hope it helps to explain it.


Julie: I had a blood clot in my leg two years ago, and it was determined I have Factor V Leiden. I take medication, exercise and watch what I eat. Is medication my only option or are there things I can do to get off the medication?

Moderator: Hi Julie, Factor V Leiden is a relatively common mutation in the gene for clotting that leads to an increased risk of DVT/PE. An estimated 15 to 20 percent of patients have this abnormality. Whether or not you will be able to reduce to reduce or completely stop your medication is up to your doctor. If you'd like more information about DVT, please visit our Web site at www.vdf.org/diseaseinfo/dvt/

Julie: Is there such a thing as "too much" exercise for someone on Coumadin? I run, hike, bike, swim, snowshoe, walk, etc.

Speaker- Dr. King: Julie - the main risk of exercise and coumadin is falling and hitting your head. You're more likely to have a brain bleed if you injure your head. On the other hand, if you're an athlete, you're probably less likely to fall because you have good reflexes. Just use common sense.


Chai: If my Mother has some problems with her blood, veins and arteries - even though she's quite aged, might I and my siblings avoid these issues if we exercise and take aspirin or some such?

Speaker- Dr. King: Chai T - I think I answered your question about how to help your mother with medicines to slow her vascular disease. She should also do exercises that are safe for her age (so she doesn't fall or injure her joints). You can find more information about PAD and exercise therapy online on VDF's Web site here: www.vdf.org/diseaseinfo/pad/exercisetherapy.php

Chai: Do I understand that all cases of PE are caused by DVT, but not all DVT results in PE? Are PE's caused by something in addition to DVT?

Speaker- Dr. King: Concerning DVT/PE - Deep vein thrombois (DVT) is a clot in a deep vein, often in the leg, but it can be anywhere, such as in a vein in the pelvis. Most DVTs do not cause blood clots in the lungs, pulmonary emboli - just swollen legs - but when they do they can be deadly, which is why detection and treatment are so important. Pulmonary emboli are the result of DVTs. Risks for DVTs are recent surgery, prolonged bed rest, prolonged airplane flights, hormone therapy, pregnancy, or birth control pills, cancer, previous DVT or PE, or obesity.


Rob: I'm 50, was diagnosed with arteriosclerosis at 42 when two heart arteries received stents. At age 47 underwent bypass surgery where 6 arteries were bypassed. Since initially being diagnosed have been exercising (regularly), eating low fat (Dean Ornish diet) foods, and attempting to reduce stress. Recently, learned of importance of Nitric Oxide in lining of vessels and the role which it plays in averting plaque build up. Would I be well served to consult a Vascular Specialist for a more preventative approach to my disease, rather than a Cardiologist (plumber)?

Speaker- Dr. King: Actually, most cardiologists are not plumbers - just the "interventionalists". You should find a cardiologist who specializes in preventive cardiology to go over your medication regiment with you to assure that it aggressively treats your risk factors. Exercise and some of the medications increase the ability of your blood vessels to respond to nitric oxide. You have been doing the right things - congratulations!


Carole: How soon after a DVT can one safely exercise? I am a runner but am worried about getting a PE. Do I have to pace it slower at first? (I am on coumadin now). 

Speaker- Dr. King: Concerning your question about DVT and exercise - we're beginning to learn more about this. In general, it's OK to do usual activities of life soon after a DVT. We actually allow patients to go to therapy in a rehab hospital one or two days after they're diagnosed. We don't know really know the answer about vigorous exercise, but common sense needs to prevail. In general, it makes sense to wait until the blood thinner has built up and the leg is less swollen before returning to the gym.


Moderator: This next question was e-mailed to us ahead of time: I was informed that poor thinking, degraded decision making abilities can come from hardening of the arteries (atherosclerosis). But reading your sight describes it in Peripheral Arterial Disease (PAD) which the site describes problems in the legs. What particular hardening of the arteries leads to poor thinking?

Speaker- Dr. King: Concerning atherosclerosis in the brain and thinking - there are several types of brain blood vessel disease that can cause problems with cognition (memory, problem solving, and insight). The most obvious is when someone has a stroke from blockage in one of the larger blood vessels to the brain that causes damage to an area of the brain involved in thinking. These can be difficult to detect if the blockage is in an area that doesn't also affect movement or speech. Another type of stroke can be from high blood pressure that causes damage to small blood vessels (lacunar stroke) and people can have many small strokes that, over time, cause memory problems. The good news is that the risk factors for these strokes are the same as for other blood vessel disease, like control of blood pressure, cholesterol, and diabetes, exercise and not smoking. Finally, some strokes are caused by blood clots that move from the heart or the aorta (the big blood vessel from the heart), causing an abrupt blockage of an artery in the brain. These are treated with coumadin. 


Barbara: I have PAD, my ankle arteries have narrowed. Why can't doctors help that area to increase blood flow? Thank you!

Speaker- Dr. King: Barbara - those blood vessels are too small for small for stents or surgery and actually respond well to exercise. There have been some articles about exercise in the other sections above. Are you sure that the blockages are just in the ankle arteries or do you have a low ankle brachial index (ABI) which just means there are blockages somewhere in the legs? 

Moderator: Thank you all for joining us today and thanks to Dr. King for her time. Please join us on Tuesday May 5th for our next chat at 4pm EST. We wish you a healthy day!

Disclaimer

The material provided on VDF's Web site and Live Ask the Doctor chat are for educational purposes only and are not to be used as a substitute for professional medical services or advice. For more information, please read VDF's important disclaimer.