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Interactive Learning : HealthCast Transcripts

Episode 3 : More about VDF, PAD, and Answers to Frequently Asked Questions

Release Date: October 30, 2006

Dr. David Meyerson:  Hi, I'm Dr. David Meyerson, cardiologist at Johns Hopkins, national spokesperson for the American Heart Association and your host for this week's edition of Vascular Disease Foundation's HealthCast.  We're very excited to be able to bring you excellent, easy to understand science on all topics relating to heart and blood vessel diseases as a public service.  As a public education forum, the Vascular Disease Foundation is made up of representatives of the premiere medical and science advisory groups in the country that relate to vascular diseases.  These are groups that use peer-reviewed science to verify that the information you are getting is nationally recognized as the very best and most reliable data available.  Prior episodes in this series have dealt with exactly who the parent organizations of the Vascular Disease Foundation are, the spectrum of vascular diseases and how the noninvasive laboratory, those lab test that are performed without needles, catheters, and discomfort can be used to screen for such problems as carotid artery disease, that's the narrowing of the arteries in the neck that nourish the brain which can cause stroke, threatened strokes called transient ischemic attacks, coronary artery disease, narrowings of the arteries that nourish the heart muscle that can cause angina, the chest pain you get when too little blood supply and oxygen gets to your heart muscle and can cause  heart attacks, and abdominal aortic aneurysms, the bulging and weakening of the major blood vessels of the abdomen which can cause life threatening blood loss.  Finally, peripheral arterial disease.  We've spoken about that, we're going to deal with that again today.  Narrowings or blockages in the arteries that nourish the legs which can limit your ability to walk, which can cause pain, ulcers in the leg, and in extreme situations, can even cause one to risk of amputations.  These are largely preventable diseases and once developed they are very treatable diseases and the early recognition and treatments can prevent your disability, promote your physical well being, and help you maintain the healthiest and most active lifestyle you possibly can.

I'd like to reintroduce our HealthCast audience to someone whose been before our HealthCast microphones before that is Dr. Kerry Stewart.  He's Director of Clinical and Research Exercise Physiology at Johns Hopkins and he's a member of the Board of Directors of the Vascular Disease Foundation.  Dr. Stewart, thank you for being with us once again.

Dr. Kerry Stewart:  Thank you Dr. Meyerson and again thanks for hosting this show.  I think we're bringing extremely important messages to the public and we hope to be able to cover the wide arranges of vascular diseases, as you mentioned.  These are pretty exciting times for the VDF and I'd like to just tell you about some national effort that's going on.

Dr. David Meyerson:  What are some of the most recent activities of the Vascular Disease Foundation and then if I could ask you to define, what is the PAD or the Peripheral Arterial Disease Coalition?

Dr. Kerry Stewart:  Well, that's exactly what I was going to tell you about.

Dr. David Meyerson:  Funny I should ask.

Dr. Kerry Stewart:  Yeah, funny you should ask. Well the VDF -- all these acronyms can be a little mind boggling at times, not only for the listener, but certainly for us, but the VDF has been behind the formation of the national PAD Coalition.  We initially brought together fifteen organizations and that resulted in getting a commitment from the National Heart, Lung and Blood Institute of the National Institutes of Health in Washington.  They've agreed to fund a three-year, over two million dollar campaign to increase public awareness about PAD

Dr. David Meyerson:  Now these sister organizations are the premiere health education and research organizations in every area relating to vascular disease, are they not?

Dr. Kerry Stewart:  Absolutely and while we started with fifteen organizations, the Coalition has now grown to nearly fifty organizations and represent the fields of medicine, surgery, radiology, nursing, rehabilitation, ultrasound, among others.  Podiatry, diabetes -- all of these specialities that are somehow involved in vascular diseases have come together to make the public aware of the importance of knowing whether or not they have PAD because as we've discussed on previous programs, there's an awful lot that can be done about it.

Dr. David Meyerson:  And it's something that people just don't know enough about and that's our reason for being here.

Dr. Kerry Stewart:  It's one of the most important diseases that the public is least aware about.  For more information about PAD, you can go to the PAD Coalition's website which is www.padcoalition.org or there are links to the PAD Coalition website from the Vascular Disease Foundation's website which is www.vdf.org and the NIH also has a website called aboutpad.org so there are multiple sources of information for patients and over the next couple of months, there will be many messages coming out on radio, television, newspapers, etcetera.

Dr. David Meyerson:  And many of these podcasts as well.

Dr. Kerry Stewart:  Absolutely.  One of the other advantages, Dr. Meyerson, of doing these podcasts is that we will make an attempt to answer some of the questions that our listeners send in to us.  Our VDF website has been online for approximately four years. We've received hundreds of questions from viewers who have questions about some of the symptoms they may be having, some of the treatments they may be taking, some of the things that their doctors have told them and what we'd like to use this podcast for is to try to answer some of these questions.  Now keep in mind that we can only answer questions in a general way.  This is no way intended to replace diagnosis or treatment or interaction with a personal physician.  Every question that we receive that we will look at, we will screen them carefully to make sure that what we repeat on the air or what we put on our website is something of more of a general interest.  Please do not send us all the details of your life history because it's not possible to make a diagnosis or to any kind of treatment, obviously, over the internet.  This is where you have to have a direct interaction with your personal physician.

With that in mind, let's take the first question.  I hear the terms PVD and PAD used a lot when describing my condition.  Is there a different in these terms?  Do I have two separate diseases?  Well, yes and no. PVD stands for peripheral vascular disease and PAD stands for peripheral arterial disease.  They have often been used interchangeably and PVD was the standard description for many years.  The following an international conference on definitions, healthcare providers decided to switch to using the term PAD because it more accurately describes the atherosclerosis that affects the arteries.  PVD is considered a broader term that involves more than just atherosclerosis in the artery.  So while there has been an attempt to separate the terminology, I would imagine that over the next few years, the medical community will move more towards using the term PAD, but don't be surprised if you hear PVD still being used by many people.

Question from a listener.  I'm fifty-seven- years-old with a family history of PAD.  I'm interested in knowing the things I can do to prevent it.  Well first of all, not smoking is one of the most important things you can do.  Even limited amounts of tobacco can be a major detriment in a patient's battle against peripheral arterial disease.  Nicotine, the main substance in smoking, in smoke, causes the blood vessels to narrow leaving less room for blood flow and increases the risk of blood clot formation.  Overall, tobacco is one of the most damaging things to the blood vessels.  Another important consideration is lowering cholesterol levels.  Lowering cholesterol is extremely important because it's the main substance that's found in the plaque that builds up in the arteries.  As to lower your blood sugars and very importantly use proper foot care.  Be sure to take all your medications exactly as described. Exercise is another important component in fighting PAD.  An appropriate level of physical activity will keep you heart healthy and walking is consistently the most effective treatment for those with intermittent claudication which refers to pain in the legs due to PAD.

Here's another important question.  I was told that my ABI test was inconclusive because I have diabetes.  What does that mean?  The ABI stands for the ankle-brachial index and compares the blood pressure measured at the ankle to the blood pressure measured at the brachial artery which is located in the arm.

Diabetes can cause the artery wall to become calcified or hard and the blood pressure cuff cannot compress the artery to get a pressure particularly at the ankle.  As an illustration, think of water flowing through a garden house in a pipe in your home.  You can bend the hose, but not the pipe.  Well calcified arteries are stiff and more like a pipe and blood pressure measurements cannot be performed.  Without an ankle pressure, there's no comparison then for an ABI.  When this occurs, often a toe pressure is compared to the arm or the doctor may look at wave forms from another study known as a doppler ultrasound to help determine how much blood is actually flowing to the legs.

And the final question for this episode is, I just got out of the hospital where I had toes and part of my foot removed because of vascular disease.  I also had a vascular bypass in my left leg.  Will exercise like on a stationary bike help?  The answer to this question is a definite yes.  Bicycling, like most forms of exercise, are good for cardiovascular health and to keep the muscles in tip top shape.  When you're able, it's important to start walking again.  Walking uses the muscles that are affected specifically by PAD and leads to improvements in circulation and the ability to walk further with less pain.  Ask your doctor to provide some specific instructions for exercise based on your condition and the results of any testing that might be deemed to be appropriate.  The scientific literature, and there's been many studies on this topic, have shown consistently that people who participate in a supervised exercise program tend to do better, particularly in the first several months than those who attempt to do it on their own.  With that of supervised programs for people with PAD has been a problem.  However, in the last few years many cardiac rehabilitation programs have been offering services for people with PAD and the national directory of cardiac rehabilitation programs can be found through the American Association of Cardiovascular and Pulmonary Rehabilitation or AACVPR.  You can find more information at the AACVPR website which is www.aacvpr.org.  AACVPR is a member of the Vascular Disease Foundation and the PAD Coalition.  For those of you that can't participate in a supervised exercise program, we have provided on the VDF website at www.vdf.org, instructions to start a home-based walking program and have included walking progress logs which can be used to help keep track of the progress you make as you walk over the course of several months.  Like any set of instructions that you might find on the internet, these are only intended to be a general guide using the general principles that apply to exercise training for people with peripheral arterial disease. It's very important to consult with your physician so that you can maximize the benefit, while at the same time minimizing the risk of injury or harm.

Dr. David Meyerson:  On behalf of the Vascular Disease Foundation, my guest has been Dr. Kerry Stewart of Johns Hopkins.  On behalf of the Vascular Disease Foundation, I'm Dr. David Meyerson, thanks for listening.

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