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

Interactive Learning : Ask the Expert

 

Ask the Doctor Live Chat Transcript - Tuesday, November 2, 2010

Carmel Celestin, MD

Cleveland Clinic

 

 

 

Moderator- VDF: Welcome and thank you for joining us today! You may now go ahead and send Dr. Celestin your questions. We appreciate your patience as she works to answer everyone's questions.


Dan C: My mom is 86, in Little Rock. Good general health lives alone and drives. Takes Plavix due to 2 small mini strokes last year. No residual problems there. Takes HTN meds, controlled. She has one kidney and Creatin is good and she has PAD. Recently had CT Angio and has almost total blockage of super femoral arteries, BUT the only symptoms is pain while walking in malls and on tread mill. No discoloration. Good offshoot arteries. No rest pain. We went to her cardiologist who was reluctant to do stents in superficial arteries. Went to vascular surgeon who saw blockage in groin area (before the descending arteries begin) and who said he could do Endarterectomy in that leg in that area of groin and artery he saw on the CT. He put her on the exercise 4 days a week on a treadmill and Pletal to help tolerance first. Can I just ask for your comments on mom’s condition. She actually is walking farther before pain starts. Can you comment on the exercise plan AND on the problems with Endarterectomy, if any?

VDF Moderator:  Hi Dan, I would be happy to send you a brochure on walking and PAD. Please e-mail us at info@vdf.org if you'd like a free copy.

Dan C: Yes I will! I’ve looked around here and there is NO PAD therapy rehab

Speaker- Dr. Celestin: Hi, Dan-this is an excellent and detailed story you have given. The primary recommendations for the management of PAD IS exercise therapy. Usually any procedure is reserved for those who have what we called lifestyle disabling symptoms. The type of procedure done is based on where the disease is and how it looks on imaging. Endarterectomy is still a good procedure, but again, it depends on a lot of factors.

Dan C:  I’m afraid of 2 things, losing her foot and emergency surgery because it closes up too fast.  Is it normal for the person to lose the foot in a fast time period?  She says she can tolerate the pain and do the walking and all, but is afraid to lose the foot or have to do an emergency fast surgery

Speaker- Dr. Celestin: Another excellent question, Dan! Surprisingly only a minority of patients that have PAD (about 5%) will wind up needing amputation or require emergency surgery due to the artery clotting up quickly.

Dan: Awesome, thanks again, I emailed to get a copy of the walking brochure

VDF Moderator:  Great, we'll include a few other relevant brochures and articles for you as well.  If your mom's doctor is willing, we have a PAD Exercise Toolkit available for free that her HCP would access and create a program for her!

Dan C. this is great, I just lucked out and happened on this site. If her doc is willing how can he access or "get" the pad exercise tool kit you mentioned?

VDF Moderator: We're glad you found us today Dan! We will send you the link back in an e-mail.

Dan C: Tremendous! Dr. do you like Pletal as an additional therapy for PAD? Is it ok to take Pletal AND Plavix like mom does?

Speaker- Dr. Celestin: Yes, I do like Pletal for selected patients. Pletal is contraindicated with congestive heart failure, so would not use in these patients.

Dan C: A cardiologist said that when mom does the walking program and "pushes" a little, there are created small blood flow passed the clogged arteries is that right?  Is that why she gets blood down there to the foot even though her superficial femoral is clogged

Speaker- Dr. Celestin: This is correct, our bodies learn to adapt and create "bypass pathways" to get blood flow to the foot.

Dan C: Dr. when mom is sleeping, only at night, she feels jerking or spasms in legs. Lying flat and only at night. Is that a symptom of PAD or maybe other related? This may be "touchy" but is the best specialty a cardiologist or vascular surgeon. I detect some friction in the specialties around here? I mean to deal with and do intervention in PAD

Speaker- Dr. Celestin: PAD in the later/advanced stages can cause leg symptoms at night. What you are describing, however, seems to be another process. Would, however, confirm with her doctor. Symptoms are usually constant. Perhaps looking for other causes that may mimic PAD may be investigated, such as arthritis of the spine as this may be contributing. In terms of your other question-you are correct. I am a Vascular Medicine specialist so it is not touchy to me. I have referred patients needing intervention to both-it depends on the location of the disease, patient's risk factors, etc.

Dan C. Yeah mom has bad osteoporosis and seems to wonder if some is that or PAD pain...referred pain and otherwise.  Is massaging the arteries a help or a no-no if you have a blockage?

Speaker- Dr. Celestin: I would say massage neither a help nor a no-no if you have blockage.

Dan C: OK, Dan C. this was great and a big help...I emailed to get walking brochure and link for her cardiologist to look at to get mom on PAD rehab. __________________________________________________________________________________________________

VDF Moderator:  This next question was e-mailed to us ahead of time from Eddie: What is the ideal protocol for evaluating ones vascular state in terms of well being, build up, etc. Recommended labs and non invasive evaluation would be most appreciated. Thank you.

Speaker- Dr. Celestin: Eddie, usually, symptoms are the driving force to evaluate one's vascular status since a vascular evaluation can be that of arteries or veins which are distinctly different. Also, this (arteries) can be evaluated based on risk factors such as diabetes, heart disease, hypertension, or smoking in those without symptoms. For example, in someone who has leg symptoms that alert one that he/she may have arterial disease or if they have the risk factors for such as mentioned, the doctor may do a simple test such as the ankle-brachial index, where they take the blood pressure in the ankle and compare it to the blood pressure in the arms-these should be the same-if not, then it is likely that they may have peripheral arterial disease. __________________________________________________________________________________________________

Susie: My dad is a diabetic on dialysis. He has discoloration in his hands and feet. Is this Raynaud's syndrome or something else?

Speaker- Dr. Celestin: Hi, Susie-there is an array of things that may cause discoloration in the hands and feet, including Raynaud's. You should discuss this with your doctor who would do a thorough history and physical along with labs to get to the etiology.

Susie: Thanks. I'll try to get him to do that!

VDF Moderator: If you'd like more information on Raynaud's you can find information on our Web site at: http://www.vdf.org/diseaseinfo/raynaud/

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VDF Moderator: To our participants today, if you are not already signed up for VDF's free educational magazine, you may e-mail us your name and mailing address to: info@vdf.org or sign up online for a free subscription at http://www.vdf.org/keeping-in-circulation/


Akamoomoo: PAD in the arms, when the muscles are tired you just rest them as in stopping when walking. Are there arm exercises to help with these arteries as well?

VDF Moderator:  PAD in the arms is very rare. There is a study underway to see if arm cycling would be a new treatment for PAD. You might like to read the article here: http://www.keepingincirculation.org/article

Akamoomoo: By the meds keeping my heart rate down, it seems when I try to hurry or mentally hurry which raises the heart rate it seems my heart rate is too strong for my breathing and the breathing and heart rate have to balance out before I can continue on.  I would love to increase my walking pace but my heart rate being kept low by the meds will not allow it. I am 55, heart attack, CAD and PAD 7 yrs. I would like to receive a walking brochure and tool kit as well. thanks.

Speaker- Dr. Celestin: Hi, Akamoomoo. Without a full knowledge of your history, I am unable to answer this question. You should discuss with your doctor.

VDF Moderator: We would be delighted to send you a copy, please e-mail info@vdf.org or call us at 888.833.4463.

Akamoomoo: Should you not sit longer then a certain amount of time before getting up to walk around?

Speaker- Dr. Celestin:Are you referring to the risk of deep vein thrombosis? For this, I usually tell people to get up and walk after being seated for about 2 hours (plane rides, long car rides, etc). To clarify my statement I tell people to get up and walk around every 2 hours.

Akamoomoo: Does weather affect PAD being some days are better than others?

Speaker- Dr. Celestin: I am not aware of a relation between weather and PAD.

Akamoomoo: does green or black tea do anything for the arteries?

VDF Moderator: There is no research to prove any kind of tea affects artery disease
VDF Moderator: Thanks to everyone for joining us today! VDF's P.A.D. Coalition also has some great educational resources on PAD: http://www.padcoalition.org/about-pad/
Julia: In a walking-exercise program for PAD, is it better to walk a long distance at same pace, or walk shorter distances at increasing faster paces?

Speaker- Dr. Celestin: Hi, Julia-typically a PAD walking program is based mainly on working with someone to walk (at their own pace) until experiencing pain. I am not aware of a benefit difference between the pace walked. This is a great question.

Julia: Thank you I will continue walking at my own pace

VDF Moderator: Would you like us to mail you a free copy of our PAD walking brochure? If you're interested, please send an e-mail to info@vdf.org with your address.

Julia: Yes I would like a free walking brochure; I will sign up for one. That is great you have these available. Can (deep vein) thrombosis cause heart failure?

Speaker- Dr. Celestin: DVT cannot cause heart failure unless it is associated with pulmonary embolism. Some pulmonary emboli can cause heart failure. These are usually the very large pulmonary emboli.


Maria: Dr Oz said that people with PAD shouldn't take pseudoephedrine. Why is that?

VDF Moderator: Hi Marie, there is no known research that we are aware of that says you should not take pseudoephedrine. I did a quick Internet search and did find this study if you're interested: http://www.sciencedirect.com

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VDF Moderator: Thank you all for joining us today, I know most of our questions are about PAD today, but if you'd like to learn more about DVT, please visit http://www.thisisserious.org. There is an excellent patient video featuring 3 compelling real life stories!


VDF Moderator: This next question as also e-mailed to us ahead of time: I understand that blood clots and air travel are a risk for clotting...is this also true for PAD?

Speaker Dr. Celestin:I am not aware of a relation of risk of air travel with PAD and clotting.


VDF Moderator: Thank you all for joining us today and thanks to Dr. Celestin for her time. 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.