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

Interactive Learning : Ask the Expert

 

Ask the Expert Live Chat Transcript - Tuesday, July 6, 2010

Robert Schainfeld, DO


Associate Director of Vascular Medicine at Massachusetts General Hospital

 

 

 

Dr. Schainfeld generously donated his time to answer our patients' general questions about vascular disease. The below transcript details all of the questions asked by our participants as well as his answers.

Moderator- VDF: Welcome everyone! Thanks for joining us today, we're glad you're here! You may now go ahead and type your questions for Dr. Schainfeld to answer. We appreciate everyone's patience as he works to answers everyone's questions.


Jean C: Dr. Schainfeld, I was diagnosed with leukocytoplastic vasculitis last year after an outbreak of a papular/pruritic rash. After discontinuing zetia and niaspan for increased lvr. enzymes, the rash went away. I do continue, however, to have a milder form of this rash come and go. I am wondering about some foods etc. that I may be sensitive to? Also, I notice that when I go to swimming pools, I have another type of rash...have there been any reports of people that may get leukocytoclastic rashes from chlorine? Thank you.

Speaker- Dr. Schainfeld: Dear Jean, Thanks for the query. That is an interesting scenario, and the answer is not simple. In regards to the recurrent rash: it’s difficult to implicate chlorine for vasculitic induced rash, but certainly it appears that multiple offending agents may explain genesis of the rash, independent of your leukocytocalstic vasculitis. Not sure I know for sure, but I doubt they’re related.


Sue: How long will a stent stay open? Also, if prone to getting clots will that make a difference?

Speaker- Dr. Schainfeld: Dear Sue, What artery or vein was stented? And where? -Thanks, Bob

Sue: A vein in the thigh

Speaker- Dr. Schainfeld: Sue, it is unusual to stent femoral veins, although if it is a vein and is located in the thigh, it sounds as though that may be just the case. Femoral vein stents are dependent upon how many you have as well as the size of the vein/stents to dictate how well they stay open/patent. Depending on the scenario and how many times a DVT/Thrombus occurs, that would dictate how long to anticoagulate. -Bob

Sue: Just to clarify - the stent is more likely to stay open as long as I take coumadin? If I stop taking it, it would start plugging up over time?

Speaker- Dr. Schainfeld: I think that is a fair assumption. If the stent in your thigh is in the femoral vein, I would think (without knowing details) that coumadin will help keep it open.


Mary-Lou: Dr. Schainfeld, I was wondering if people with Raynaud's disease experience problems maintaining body temperature in other locations besides hands and feet.

Speaker- Dr. Schainfeld: Mary-Lou, Thanks for your question. Usually just fingers and toes with Raynaud's, but it can affect ear lobes, cheeks, and the tip of the nose, although this is much less likely. –Bob

Moderator- VDF: Hi Mary-Lou, I thought you might like to read some additional information about Raynaud's from our Web site: http://www.vdf.org/diseaseinfo/raynaud/

Mary-Lou: My friend's family says they have small arteries. How does one know whether or not they have small arteries, and what are the implications of this condition?

Speaker- Dr. Schainfeld: I'm not sure if it's important to know whether one had big or small arteries. It's based on body size. They only have impact if one is having symptoms that need treatment (such as balloon or stenting), then bigger arteries tend to stay open better than small, but I would not routinely look at "big" vs. "small" arteries.

Mary-Lou: That makes sense. I have one more question: I have PAD and have been having problems with sciatica for the past couple months; is there any connection between the two?

Speaker- Dr. Schainfeld: There is NO connection between PAD and sciatica, -Bob


Penny B: Hi Dr. Schainfeld, I think my mother may have PAD; what's the best way to tell? I read online about the symptoms and about the 'ABI' - what is this test?

Moderator- VDF: Hi Penny, The ankle-brachial index (ABI) is a simple, reliable means for diagnosing PAD. Blood pressure measurements are taken at the arms and ankles using a pencil shaped ultrasound device called a Doppler. A Doppler instrument produces sound waves (not x-rays) and is considered noninvasive because it does not require the use of needles or catheters. The ABI test is simple enough to be performed in any doctor's office or vascular laboratory. Not only is the ABI one of the most reliable tests for PAD, it is also the least expensive. You can find more information on our Web site: http://www.vdf.org/diseaseinfo/pad/anklebr…

Penny B: Thanks, what do we do if she's diagnosed with PAD?

Speaker- Dr. Schainfeld: Try an exercise program; it’s best to walk at a favorable pace to induce the claudication pain sooner, walk through the pain, and when absolutely cannot walk further due to pain, stop and then walk to pain again, stop and continue that scenario. This should be done 30-45 mins/ day, 4-5 times/week. This yields the best results and you should continue indefinitely. Try hills and a brisk pace/random route to keep an interesting and varied program. -Bob

Moderator- VDF: Hi Penny, Dr. Bob also recommends that you seek a vascular medicine doctor. You can search for a doc via this link on our Web site: http://www.svmb.org/clinical_archive/find_…


Sara M: What is the difference between cardiovascular and vascular disease? My father has been referred to a vascular surgeon. Am I the only one who finds this confusing? Sorry!

Speaker- Dr. Schainfeld: Sara M, Thanks for the question. CV (or cardiovascular) disease, implies to me, cardiac or coronary artery disease, while vascular disease, implies PAD, or arterial disease, beyond the aortic valve or in the peripheral vasculature. The latter disease is usually treated by vascular surgeons, vascular medicine specialists or cardiologists. -Thanks, Bob

Sara M: Which disease is worse for you - cardiovascular or vascular?

Speaker- Dr. Schainfeld: Sara M., neither CV or vascular disease are good to have. If there is vascular disease, there is an 80% likelihood of having CV disease as well, but it may be silent.


Joe B: How much or what is the difference between Plavix and Coumadin?

Speaker- Dr. Schainfeld: Plavvix is an antiplatelet drug, coumadin is an anticoagulation drug. The former is better for arterial atherosclerosis/blockage, while coumadin is better for atrial fibrillation or blood clots in veins. -Bob


Maria B: I have very bad PAD in both legs. My question is that the normal procedure is to balloon and stent the artery; which in my case the neurosurgeon has already ruled out and tried twice.  Why can't they come up the artery with a laser and suction cath and remove the blockage? Thank you for your time to answer.

Speaker- Dr. Schainfeld: Maria B: The blockage/PAD was in your legs, and it was treated by neurosurgeon? Or vascular surgeon? If balloons and stents are not working, then bypass procedures may be indicated. There are lasers and "rotorooter" devices that can be used in select cases.


Moderator- VDF: This next question was e-mailed to us ahead of time: I have had Breast cancer, and during Chemo, a clot in my leg formed and went to my lung. That was dealt with but my leg is thick, hard and very painful. I saw a Doctor and saw she wrote Left leg edema BHX of CVT in left leg. What does this mean?

Speaker- Dr. Schainfeld: CVI= chronic venous insufficiency, related to a blocked vein from DVT; treatment with elevation, blood thinners and daily support hose stockings.

Moderator- VDF: This next question was also e-mailed to us ahead of time: What is the current thinking about using drug-coated stents to restore and maintain blood flow in the lower legs that have PAD?

Speaker- Dr. Schainfeld: DES= drug-eluted stents are not commercially available for us in the USA, and thus not able to be used. There are trials on-going, so I recommend you wait to see where and how it fares in years to come. -Bob

Moderator- VDF: This next question was e-mailed to us ahead of time: I am a 43 yr old female and have had raynaud's for 30yrs.  Lately, I have developed purple, numb, and very painful fingertips (2 fingers on the R hand), which does not change, and is not going away.  Is this a complication of Raynauds? What can be done? Also can deep tissue: [massage] can help someone with raynauds disease?

Speaker- Dr. Schainfeld: Raynaud's, if after 30 years, may represent either primary (without relationship to underlying illness), or secondary (which may have underlying disease, which can develop purple lesions), which may be a manifestation of underlying illness. Also, I doubt deep tissue massage has a role.


Margaret M: what is the risk of having a stent put in your leg to help with circulation?

Speaker- Dr. Schainfeld: Margaret M: stents for circulation are pretty safe; the risk is in the disease itself more so than the procedure- e.g. clotting off stent, rupture of the artery, bleeding, infection, are all rare complications.


Moderator- VDF: This next question was e-mailed to us ahead of time: I have a long-history of venous ulcers...Is there anything else that I can do to prevent another ulcer from occurring?

Speaker- Dr. Schainfeld: the recurrent venous ulcers: avoid trauma, maintain excellent wound hygiene, keep your legs/feet well-moisturized, keep your weight down, exercise, and wear compression stockings EVERYDAY. Also, pay close and early attention when wounds first appear; get to a wound center.


Ginny: I have had a DVT/PE 1 year ago. Now another dvt in other leg. I am on coumadin still trying to regulate dose. Can I get another dvt while on meds?

Speaker- Dr. Schainfeld: Ginny, you can indeed get another DVT while on meds, but the risk is if the coumadin (if that is med) is not well regulated. I would hazard a guess you will need to take blood thinners for life, and need close monitoring of dosage and levels.

Ginny: Do you know of any patients feel really awful on blood thinners?

Speaker- Dr. Schainfeld: Yes I do, but the trade-off is that it appears they really need to be on the meds, and at this time there are no other options.

Moderator- VDF: Hi Ginny:, you might also like to read this patient's guide to taking blood thinner: http://www.keepingincirculation.org/articl…


Sue: Will there be something other than coumadin someday soon? Something that doesn't require so much monitoring? It's such a pain.

Speaker- Dr. Schainfeld: Sue, excellent question. There is on the horizon, perhaps within the next year or so, an oral drug for DVT/PE (venous clots) that will still need monitoring. It’s awaiting FDA-approval, and will be slow to reach the market. Many are worried about safety to date, which is slowing the release from the FDA.


Anne: I bruise very easily. Does this increase my chances of having a blood clot?

Speaker- Dr. Schainfeld: Anne, Luckily bruising does not increase your risk of blood clots, so just be careful. Are you on any meds that predispose you to bruise such as aspirin?

Anne: I don't take any medications regularly. What would cause bruising so easily?

Speaker- Dr. Schainfeld: Your skin integrity is that it may be thin-skinned. Otherwise, it can be a manifestation of a blood or platelet disorder, although it is rare that that be the case. Be careful with any trauma.


Moderator- VDF: This next question was e-mailed to us ahead of time: I would like to know what type of a doctor I should see to prevent the development of another ulcer.

Speaker- Dr. Schainfeld: Re: Venous ulcers and development, UI would favor a vascular specialist in vascular medicine, vascular surgeon, or vascular radiologist. Depending upon the resources in your area, that will dictate who best to see.

Moderator- VDF: This next question was also e-mail to use ahead of time: Please tell me if using my stationary bike is equivalent to walking to control my PAD.

Speaker- Dr. Schainfeld: Walking on either a treadmill or just plain walking is the BEST exercise modality for PAD. Walking is better than stationary bikes, but any exercise will still be of benefit.


Ginny: Is walking and running OK to do with a DVT?

Speaker- Dr. Schainfeld: Ginny, Either walking or running, WITH stockings is good for DVT.

Ginny: I have stockings but cannot wear them; they really hurt.

Speaker- Dr. Schainfeld: If you cannot wear your existing stockings, you might want to have a new pair fitted, perhaps with less compression/grade.


Moderator- VDF: This next question was also e-mailed to us ahead of time: I am a victim of P.A.D. which is in an advanced form in both calf muscles, to the extent that my walking ability is limited too about 15 to 20 metres. This situation has resulted from a triple by-pass in 1997. April 2010 the left leg was stented. A scan was carried out two weeks later to check the scan, and all appear okay. On the 29th June 2010 the Hospital again scanned it. The result was that the scan revealed considerable blocking, and there is considerable pain attached to the leg. I understand the stent cannot be removed. I am told my only options are a graft to divert the blockage. Evidently this can be undertaken, using my own tissue:, and My second question is, are there and alternatives that exist, to a positive outcome to this problem? possibly blocking again within six months.The other alternative is the same process with artificial material which may block within five months.  Can any of your specialists direct me as to whether the time span's in relation to the functions of the grafts are correct?

Speaker- Dr. Schainfeld: Re:Grafts for blockages- veins do the best, artificial or prosthetic grafts are less satisfactory. What arteries are bypassed and where the landing zone is dictate the length of time it will stay open, in addition to many other variables.

Moderator- VDF: This next question as also e-mailed to us ahead of time: Hello- My problem is that my legs swell up and so do my feet to the degree that I cannot wear regular shoes and the pull on my legs of stretched skin hurts. I was told that I have bad veins and nothing can be one about it. I recently had 5 stents put in my heart which doesn't help but don't know if that is the result of my legs. My question is: is there any answer for bad veins to correct this problem.

Speaker- Dr. Schainfeld: Not sure whether the leg/feet swelling is related to “Bad Veins” or perhaps related to a bad heart or other potential reasons. If you can sort out WHY the swelling is occurring, that will dictate treatment options.


Moderator- VDF: Thank you all for joining us today and thanks to Dr. Schainfeld for his time. We wish you a healthy day! Please join us on August 3 with Dr. Ratchford.

Disclaimer

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.