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Interactive Learning : Ask the Expert


Ask the Expert Live Chat Transcript - Tuesday, June 1, 2010

Diane J. Treat-Jacobson, PhD

Associate Professor University of Minnesota School of Nursing




Dr. Treat-Jacobson generously donated her time to answer our patients general questions about PAD and exercise. The below transcript details all of the questions asked by our participants as well as her answers.

Moderator- VDF: Welcome and thank you for joining us today for VDF's Live Chat! I would like to introduce Dr. Diane Treat-Jaconson from the University of Minnesota who will be taking your questions today. You may now go ahead and send Dr. Treat-Jaconson your questions.

Joe F: I have PAD located in artery behind right knee 1 year ago. I still have numbness in my foot. My Dr. has taken me off Plavix. My concern is the numbness in the foot-exercise 5 times a week.

Speaker- Dr. Treat-Jacobson: Numbness in the feet can be caused by a number of conditions. Sometimes this can be caused by neuropathy, especially if you have diabetes. Usually numbness at rest is not caused by PAD. You should be very careful to inspect your foot and wear good footwear so that you do not injure your foot without knowing it. I would recommend that you consult with your doctor about the numbness if you haven't already.

Kara C: Can PAD cause aches and pains in other parts of the body, even though the right leg was determined to be where the blockage is?

Speaker- Dr. Treat-Jacobson: Hi Kara, the pain caused by PAD is usually in the area at or below where the blockage is located. Usually the discomfort is in the leg, often in the calf muscle. The pain comes during exertion and goes away with rest. You would not expect to have pain in another part of the body where there is no PAD.

Charlotte G: I just found out that my valves in both my return leg veins do not work so am wearing support socks. I walk 2 miles at least a day. Anything else I can do to help this?

Speaker- Dr. Treat-Jacobson: Charlotte, wearing support stockings and exercising are two of the most beneficial treatments for venous insufficiency, which is another term for the problem you describe. You should also avoid standing for long periods of time and elevate your feet when you are seated.

Charlotte G: Could a vein stripping in one leg 30 years ago be the cause of that same leg aching?

Speaker- Dr. Treat-Jacobson: Usually a vein stripping is performed because of venous disease, which can be associated with aching legs, even years later. You may wish to talk to your doctor and be evaluated for ongoing venous insufficiency and request compression stockings, which can often relieve the aching. Walking also helps the calf muscle pump the blood back up to the heart and can relieve symptoms.

Arlene N: Is there anything new you can tell us about to help PAD besides exercise and angioplasty, bypass surgery, anything on the horizon?

Speaker- Dr. Treat-Jacobson: There are new therapies being tested all the time. There is hope that some gene therapies will be effective but it is too early to tell yet. There have been several trials of new drugs that have been shown to be ineffective, but hopefully new effective therapies will be coming soon.

Arlene N: You told Kara that pain from PAD is usually in the area of the blockage, my leg hurts from the hip to the ankles when I walk, sometimes just sitting. Why is that?

Speaker- Dr. Treat-Jacobson: There are many causes of leg pain. Some people have more than one condition, which makes it even more confusing. The symptoms you are describing may be related to a problem with your back, such as sciatica or spinal stenosis. I would recommend that you ask your doctor to carefully evaluate your leg pain and refer you to a specialist if needed. The biggest clue with your condition is that it sometimes comes at rest, which doesn't happen with claudication (PAD) and it radiates all the way down your leg.

Arlene N: I have been to several drs. and specialists and they all tell me its from my PAD or just bad circulation in the legs. Nothing has been found in scans, x-rays etc. Should there only be pain where the bypass was done? They still have to go in about every three months for angioplasty to unblock where the bypass was done.

Speaker- Dr. Treat-Jacobson: Arlene - Unfortunately, it is difficult for me to be able to tell without seeing you. You may wish to ask for an evaluation with exercise so that you can better describe the symptoms when they occur.

Anne: My father has diabetes and from your description above, he suffers from relatively severe neuropathy. I understand that the numbness is not caused by PAD, but can it lead to PAD due to inactivity related to being unstable on his feet?

Speaker- Dr. Treat-Jacobson: Anne - I think there is considerable confusion about neuropathy, diabetes and PAD. Neuropathy doesn't cause PAD, but both neuropathy and PAD can be caused by diabetes. Often there is some confusion because many people have both conditions. It is important that a person with PAD and neuropathy be very careful to inspect his/her feet regularly because the neuropathy may make the person unable to feel if there is a sore on the foot and the PAD means that the blood flow is reduced so it is harder to heal a wound once it starts.

Maria B: Hi Dr. Treat-Jacobson: Is PAD hereditary? My father had PAD and died from a heart attack. He smoked for many years.

Speaker- Dr. Treat-Jacobson: There is a hereditary component to PAD, but there are also definite risk factors. The biggest risk factor associated with PAD is smoking. The others are diabetes, high blood pressure, high cholesterol and older age. These are also risk factors for heart disease. It is possible that the cause of your father's disease was as much from smoking as heredity.

Marlene: I am a golfer and walk quite a bit while carrying considerable weight for extended periods of time. Lately I have been noticing red areas on my legs that can sometimes take a few days to go away. Recently I was on a three-day golf trip and by the end of the second day I was in significant pain and my legs were red and swollen all around my ankles. At first I thought it was an allergy to something on the course, but I was told that pain when exercising can be a symptom of PAD. Is this something I should have looked at by a vascular doctor, or do you think it's related to something else?

Speaker- Dr. Treat-Jacobson: Marlene, The symptoms you describe do not sound like classic claudication. Usually, claudication comes in the muscles of the legs when walking and goes away with a few minutes of rest. Usually people do not complain of redness and swelling. Swelling can also be caused by vein or heart problems. You should see your doctor and discuss your symptoms and ask to be evaluated for venous or arterial disease. It is important to carefully describe when the symptoms start, the duration, what gives you relief. Also, is it still happening? This will help your doctor better diagnose the problem.

Marlene: The pain and redness usually happen while I am out walking/playing, and what helps is elevating and icing my legs. Is this something I can bring up with my regular physician, or should I find a specialist? I'm very curious now to find out what's going on, but am glad to know it doesn't sound like PAD.

Speaker- Dr. Treat-Jacobson: You are right, this does not sound like PAD. The fact that it is relieved by elevation and icing suggests that it is not caused by blockage in the arteries. Sometimes this can be caused by venous insufficiency or heart problems. You should start with your doctor and ask for a specialist if you don't get answers.

Moderator- VDF: Hi Marlene, you may read about chronic venous insufficiency on our Web site at:

Moderator- VDF: This next question was e-mailed to us ahead of time: Can you share information about the use of L-arginine in the treatment of PAD/artery diseases. Thank you.

Speaker- Dr. Treat-Jacobson: L-argenine has been tested in PAD patients in a clinical trial and was shown to be ineffective

Moderator- VDF: This next question was also e-mailed to us ahead of time: Will walking clear leg arteries of blocked arteries in time? I am 70 years old with blocked artery in one leg which causes poor circulation in my lower leg and foot.

Speaker- Dr. Treat-Jacobson: Walking will not necessarily 'clear' the blockage, but walking exercise has been shown to improve how far people can walk until they get pain and how far they can walk before they have to stop because of pain. This is likely due to improvements in the ability of the muscle to use the blood that it has. There are great instructions about how to start a walking program if you have PAD from the VDF.

Moderator- VDF: VDF has an excellent walking brochure for patients with PAD that includes a walking log. You may download the brochure online at or e-mail us with your name and address at and we'd be happy to mail you a free copy.

Arlene N: Is there anything, prescription or over the counter that does help with circulation?

Speaker- Dr. Treat-Jacobson: For PAD, that is arterial insufficiency or lack of blood flow to the legs, one drug, cilastazol has been shown to improve walking distance. This drug should not be taken if you have heart failure and you should discuss with your doctor to see if it is right for you.

Moderator- VDF: This next question was also e-mailed to us ahead of time: I have PVD. I've had many procedures including a bypass in my left leg. I would like to know if there are more options for me. I suffer a tremendous amount and my quality of life has been diminished a significant amount. My legs still hurt me even after so many procedures, it is difficult for me to walk. If there is any other course of action to proceed in combating my disease I would be delighted to hear.

Speaker- Dr. Treat-Jacobson: Try an exercise program would be something to try. She might try else if she hasn’t tried a walking program. Than she should try, arm exercise program. Just make sure to talk to her doctor.

Moderator- VDF: This next question was also e-mailed to us ahead of time: Other than walking what other exercises or stretches would help? Is there anything to prevent more closing or open arteries up?

Speaker- Dr. Treat-Jacobson: While walking exercise is the most recommended form of exercise for PAD and has the most research demonstrating its effectiveness, several studies have also shown that aerobic arm exercise, which stimulates the cardiovascular system and allows you to increase your heart rate and breathing, is also effective in improving walking distance in patients with PAD. We are currently conducting a large clinical trial to determine the relative effectiveness of aerobic arm exercise versus treadmill walking. If there is a form of aerobic exercise that you can do comfortably, that gets your heart thumping and makes you breather harder, this may be beneficial and may be worth trying. It is very important that you consult with your doctor before stating an exercise program, particularly if you want to start a form of exercise that you haven't done before or is a greater level of exertion than you are accustomed to.

Moderator- VDF: Thanks to everyone for joining us today, we appreciate your time! Thank you Dr. Treat-Jacboson for taking the time to answer everyone's questions. We wish you a great day!


The material provided on VDF's Web site and Live Ask the Expert 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.