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

Interactive Learning : Ask the Doctor

 

Ask the Doctor Live Chat Transcript - Tuesday, July 7

Peter Sheehan, MD

Sheehan Health Management Corp
Member of P.A.D. Coalition Steering Committee

 

 

 

 

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


Lorraine: I had an ankle sprain several months ago & was treated by a foot/ankle surgeon. I now have a bit of swelling, spidery looking veins, & itching. Should I see a vascular doctor or go back to my foot guy?

Speaker- Dr. Sheehan: Hi Lorraine, since the foot specialist has already examined you, it would be good advice to stay with the same specialist so he/she can evaluate whether you're getting better or worse.


Irene: I am type 2 diabetic on insulin whom also has bilateral renal Fibromuscular Dyplasia. Since both conditions affect my vascular systems is there anything I should be aware of? Also since both put me at a higher risk for stroke is there things that can be done to lower my risk and how often should my carotids be checked for Fibromuscular Dyplasia? Thanks for any help with these questions.

Speaker- Dr. Sheehan: While I don't believe that diabetes and FMD are related. You are right that both conditions may increase the risk of stroke. The healthiest thing you can do to prevent a bad outcome would be to control the blood pressure. FMD and diabetes may result in hypertension and if this is present controlling the hypertension would be your best preventative measure. To reassure you, while the risk of stroke is real it is quite small.

Irene: Thanks due to the FMD my blood pressure has been very high 230/120 while on 8 blood pressure meds this has caused me to have silent strokes. Since having 4 angioplasties for the renal arteries things are better. So the most important thing thing for me to do is try to keep the blood pressure down along with the blood sugar is this correct?

Speaker- Dr. Sheehan: Yes, Irene, that is correct. Please follow closely with your vascular specialist to make sure your renal arteries are in good shape.


Kaitlin: Why does having diabetes affect my arteries or veins?

Speaker- Dr. Sheehan: Hi Kaitlin, that's an excellent question. Diabetes is perhaps the most powerful risk factor for having cardiovascular disease. It mainly affects the arteries and the small vessels known as micro circulation. In part this is because of the cholesterol abnormalities we see in diabetes, but in addition, we believe that having diabetes causes inflammation leading to hardening of the arteries and vascular disease. We recommend that people with diabetes not only control blood sugar, but also control cholesterol, blood pressure and take something to prevent the blood from clotting such as aspirin or clopidogrel.

Kaitlin: Thank you Dr. Sheehan. So if I have diabetes, am I at increased risk for getting blood clots, like DVTs and PEs, since you mentioned clopidogrel and I think that's a blood thinner.

Speaker- Dr. Sheehan: Hi again Kaitlin, while DVT may occur in people with diabetes, they do not seem to be at increased risk than others. Aspirin and clopidogrel may help prevent the blood from clotting in the arteries and not the veins and may prevent heart attacks and strokes.


Tal: Regarding diabetes and vascular disease, does diabetes create vascular problems, or are the conditions that create diabetes also contribute to the creation of vascular disease. I ask because cancer patients have higher rates of venous disease, (DVT) that is created by the cancer.

Speaker- Dr. Sheehan: It's interesting that you should ask that Tal, diabetes is associated with the development of vascular disease, but that risk seems to begin even before the blood sugar is elevated in a phase we call "pre-diabetes." In a sense you are correct that certain factors may be responsible for the development of both diabetes and vascular disease and this is an area of active research today.

Tal: Type II diabetes seems to be a lifestyle issue to a greater extent than early onset diabetes. I understand that Type II is able to be reversed to some degree through lifestyle choices. Does that also reduce the risk for vascular disease? Some things are reversible, others not. Just curious

Speaker- Dr. Sheehan: You’re right Tal, Type II is more of a lifestyle issue rather than Type I, and a healthy lifestyle such as moderate diet and regular exercise such as walking can delay or prevent Type II. Type II also has a stronger relation to cardiovascular disease. When someone has Type II it can be often be treated successfully with healthy lifestyle alone. However, while we haven’t been able to reverse Type II, there is active research going on to test methods such as drug therapy and surgery to reserve Type II diabetes. While we believe that living a health lifestyle not only prevents diabetes and treats it, it may also prevent the development of cardiovascular disease, esp. if adopted early on. We can treat it Type II, but can not reverse it, meaning you can correct it, but will still have diabetes and will always have the disease.


Ted: I have had diabetes for many years and my doctor is always on my back about my blood pressure. How is this related to my diabetes?

Speaker- Dr. Sheehan: Hi Ted, as far as diabetes and blood pressure, there is an increased prevalence of hypertension in people with diabetes, this may be related to chronic kidney disease in type 1 diabetics and more overweight and obesity for type 2. What's important to know is that hypertension in people with diabetes has worse consequences than in non-diabetics; this is why doctors tend to be more aggressive with people who have diabetes.

Ted: One other question for the doctor - my foot doctor wants me to get special shoes. Is this worth the cost?

Speaker- Dr. Sheehan: Shoes are always a good recommendation if a person has neuropathy or vascular disease, they are the best way to prevent a foot ulcer which can lead to surgery and infection.


Maria: I have had diabetes for more than 20 years and have lost feeling in some of my toes.  My doctors says I need to be concerned with circulation problems.  How do I know if I have poor circulation in my legs?

Speaker- Dr. Sheehan: Hi Maria, The best way to screen for poor circulation in the legs, what is called peripheral arterial disease (PAD), is by measuring the blood pressure in the ankle (or the ABI). If the blood pressure in the ankle is less than the blood pressure than the arm, then there is poor circulation. We call this the ankle brachial index or ABI. More likely, the loss of feeling in your toes is due to peripheral neuropathy or nerve damage from the diabetes. For those that have neuropathy, we recommend a foot specialist or podiatrist.


Julie: I have diabetes and carefully watch what I eat. I understand that healthy eating is important for your heart, too. Is there any one particular diet to follow to keep both my diabetes and my heart in check?.

Speaker- Dr. Sheehan: Hi Julie, that's a good question that many people ask, we have tried to avoid a standard diet for all people with diabetes. We understand now that one size does not fit all, to individualize a diet we work with a nutritionist who gives a regime based on if there is diabetes, if someone needs to loose weight, etc. Off hand if someone has diabetes, in general for both diabetes and heart disease, watching fats and calories would be recommended. The best course is to see a nutritionist for a personalized plain.


Carrie: Seven years ago, I accidentally bent my right ankle and developed chronic pitted edema around the ankle and the top of the foot. I have since taken numerous tests including: MRI and Ultra sound that revealed inflammation but no tears, a CAT scan that did not indicate any bone chips, and a Doppler that revealed no blood clot. I went to a vascular specialist who said it was lympedema, but after taking a lymphoscintigraph there was no lymph blockages. So here I sit with pitted edema and no diagnosis. Can you recommend what type of doctor or test I should take next? I do not know what type of doctor I should be talking to. Could this be a circulation problem or related to a potential heart condition?

Speaker- Dr. Sheehan: Hi Carrie, the specialist to see is a vascular specialist, the important condition to rule out is DVT and apparently has been done with ultrasound. If that is negative the most likely cause is venous insufficiency and that can be managed with local compression stockings. But I would like to see you have an examination by a vascular specialist.


June: What are the numbers for a fasting Glucose on our blood tests that we get routinely? What is the range? Anything up to 100--is that good? Mine has gone to 103, and I have a sweet tooth. I will stop eating sweets if 103 is too high?

Speaker- Dr. Sheehan: Hi June, this is a very important issue, the normal fasting blood sugars up to 100, diabetes is defined as a fasting blood sugar up to 126. That gray area between 100 and 126 we now call "pre-diabetes." While we have 24 million people with diabetes, we have 57 million people with pre-diabetes. Many of these people will develop diabetes within the next 5-10 years. So we strongly recommend healthy lifestyle changes for you and others like you. This would be a modest weight loss and exercise regime 30 minutes per day /5 times per week. This can be as simple as a long walk and you should follow up with your doctor to check on your blood sugar to make sure it comes down to a normal range of less than 100.


Sandy: I heard about air pumps that help with circulation? Do they work and would they help PAD? Would they help with ulcer healing or neuropathy?

Speaker- Dr. Sheehan: Hi Sandy, air pumps have been used for several years with people with poor circulation. Many people feel they have helped them and doctors do prescribe them. Unfortunately we do not have any scientific study to prove they work, but they are not harmful and it is reasonable for you to try them.

Sandy: Thanks, do they help only circulation, or would it also help ulcers or neuropathy?

Speaker- Dr. Sheehan: Hi again Sandy, air pumps have not been proven to help with foot ulcers or neuropathy. If someone with diabetes has an ulcer, they should be seen by a foot specialist such as a podiatrist for proper care.


Cornelius: I take Crestor with my diabetes pills and my wife wants to know if I can donate blood even though I have problems with my cholesterol

Speaker- Dr. Sheehan: Hi Cornelius, not only can you donate blood, but we encourage you to, thank you!

Cornelius: I guess I should listen to my wife. I also get boils on my skin, arms, and calves. Is this from diabetes?

Speaker- Dr. Sheehan: Hi again Cornelius, the boils are a small infection in the skin due to local skin condition, not from diabetes. However, they are preventable and treatable with good skin care and medication. A dermatologist can help you with that.


VDF Moderator: This question was emailed to us ahead of time: Can arteries/veins in the calf be stented so as to end the pain of PAD?

Speaker- Dr. Sheehan: Yes, doctors have for years have used a balloon or angioplasty and stents for the treatment of narrow or blocked arteries in the legs in people with claudication. Exercise may also help with leg discomfort and there is a study ongoing comparing the two treatments to see which one is better. This is called the CLEVER trial and we're seeking recruits, visit www.vdf.org for information.


Paul: This next question was e-mailed to us ahead of time: I just started having less feeling in my right leg & it feel like I am walking on a ball, I also on high blood pressure meds, What kind of doctor should I be looking for. Thanks, Paul

Speaker- Dr. Sheehan: Hi Paul, this could be any number of things from a pinched nerve to a problem with circulation. It would be best to start with your primary care doctor for a good examination. Good luck!


Maria: Is it safe for me to exercise in comfortable shoes?

Speaker- Dr. Sheehan: Hi Maria, the answer is probably if there is no deformity of the foot. It's best to check with a podiatrist because you may benefit from a prescription for shoes.


Ann: Anti Thrombin 3 def runs in my family and several members have developed clots. My daughter was on the pill and ended up with PE. She tested negative for the disorder. My son was tested and his numbers came back in the low 40's. What does that mean?

Speaker- Dr. Sheehan: Hi Ann, thanks for taking the time to log in and asking your question, however this is not Dr. Sheehan's area of specialty. He recommends a consultation from a hematologist.


VDF Moderator: This next question was also e-mailed to us ahead of time: if I have neuropathy, will I damage my feet or make the neuropathy worse if I continue to exercise?

Speaker- Dr. Sheehan: Exercise can in fact help neuropathy under the guidance of your doctor and after a good foot examine to get properly fitting shoes.


VDF Moderator: This next question was also e-mailed to us ahead of time: does PAD cause diabetes or the other way around?

Speaker- Dr. Sheehan: Cardiovascular disease is a risk factor for diabetes which can cause peripheral arterial disease or PAD. Those with PAD will be at increased risk for developing diabetes later on.


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.