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

Interactive Learning : Ask the Doctor


Ask the Doctor Live Chat Transcript - Wednesday, November 21


Kerry J. Stewart, EdD

Professor of Medicine at Johns Hopkins School of Medicine and Director, Johns Hopkins Clinical and Research Exercise Physiology

Vascular Disease FoundationBoard of Directors




Moderator- VDF: Welcome! Thank you for joining us today. You may now type in your questions for Dr. Stewart to answer!    

Kate: I have PAD Can I ride a bike or swim in place of walking? Would either work as well?

Speaker- Dr. Stewart: Walking is the preferred mode of exercise. However, recent research suggests that other forms of exercise might be helpful. This includes cycling with the upper arms.

Moderator- VDF: This next question came to us by e-mail ahead of time: I have problems with me feet and it makes it hard to walk. What exercise can I do to help my PAD?

Speaker- Dr. Stewart: Walking remains the preferred mode of exercise. However, if you cannot walk, try cycling or swimming.

Susan: I have PAD.  What types of shoes are best to wear when walking?

Speaker- Dr. Stewart: Comfortable walking shoes are best. They should not be too tight to avoid blisters and be sure to wear socks.

Susan: Should I wear my orthotics and, can I wear an ankle wrap? How long minimally can I walk to make a difference?

Speaker- Dr. Stewart: An ankle wrap should not interfere with walking and if it provides good ankle support, the better. Just make sure that it is not too tight to reduce blood circulation to the feet. Walking should be done for up to 50 minutes.

Moderator- VDF: This next question also came to us ahead of time: Can I use compression stockings for PAD?

Speaker- Dr. Stewart: Compression stockings are used for venous circulation and not for the arteries. Therefore, if PAD is your only problem, do not wear them.

Susan: If I can only spare 20 or 30 minutes, should I do that or wait until I can have the 50 minutes?

Speaker- Dr. Stewart: Do not wait until you have 50 minutes. Do as much as you can when you can.

Kate: I have a home treadmill- can I use that instead of walking? What settings should I put it at?

Speaker- Dr. Stewart: Research suggests that the best programs are those done in a supervised setting such as at a hospital fitness center. In this way the staff assures that the exercise is carried out according to prescription guidelines. However, if that is not possible, a treadmill at home would be okay.

Moderator- VDF: This next question was e-mailed to us ahead of time: I have already had a heart attack, what kind of exercise can I do for my heart and my PAD?

Speaker- Dr. Stewart: The same kind of exercise that is of benefit for PAD is the same as exercise that benefits the heart. Therefore, a person with both problems should definitely join a supervised program to get an accurate prescription and a greater bang for their buck.

Susan: Is the important part getting the heart to beat faster, or is it to make my leg muscles work? Does going up a hill help even if it’s a slow climb?

Speaker- Dr. Stewart: It is important for the leg muscles to work. The heart rate is like a speedometer that tells you how hard your body is working but the goal is to make the legs work.

Moderator- VDF: This next question was also e-mailed to us ahead of time: Is the ABI the only test used to diagnose PAD or is there another way to know if I have it?

Speaker- Dr. Stewart: There are many tests to diagnosis PAD. However, the ABI is a simple, painless, and inexpensive method for the diagnosis. It can be done in many doctor's offices and is very accurate. An individual may be sent to a vascular laboratory for further testing if there is a possibility that a procedure will be needed. These more advanced tests can help better locate the blockage than the ABI.

Kate: Can I reverse my PAD?

Speaker- Dr. Stewart: There is not much research suggesting that PAD can be reversed in terms of reducing the size of the blockages. The treatments initially are to reduce symptoms, mainly through walking, and to reduce cardiac risk factors like smoking and controlling diabetes to prevent the development of heart attack and stroke. In more severe cases of PAD, surgical intervention may be needed to open or bypass the artery.

Moderator- VDF: This next question also came to us ahead of time by e-mail: I have PAD and neuropathy and can't walk because my feet hurt, what else can I do for my PAD? I'm also afraid that I'll make my neuropathy worse if I walk.  Is that true?

Speaker- Dr. Stewart: Neuropathy may or may not interfere with walking. That depends on the severity of the neuropathy and if it causes imbalance. An important consideration for someone with neuropathy is to inspect their feet daily since they may have a blister, cut or ulcer that they do not feel. If untreated it could lead to serious problems.

Kate: Is air travel safe with PAD?

Speaker- Dr. Stewart: Air travel should be okay as along as you take the appropriate precautions. Drink lots of fluids and get up frequently to move around to avoid keeping your legs immobile for a long period of time. If you have PAD, you might already be taking medicine that prevents clots so that should help.

Linda: I understand that vascular dementia is different than Alzheimer’s. Could you please say what exercises might help slow the progress of vascular dementia?

Speaker- Dr. Stewart: Vascular dementia is usually caused by the same process that causes stroke. In fact, this condition often results from ministrokes. Exercise reduces many of the cardiovascular risk factors like high BP and cholesterol, and reduces blood sugar levels, so to the extent that it prevents stroke, it should help prevent vascular dementia.

Moderator- VDF: This next question was also e-mailed to us ahead of time: I have been taking Petal for my intermittent claudication for a while but recently my doctor switched me to cilostazol. Are these drugs the same thing?

Speaker- Dr. Stewart: Yes, they are the same--Petal is the brand name.

Moderator- VDF: This next question was also e-mailed to us ahead of time: What foods should I avoid if I have PAD, is there anything special I should know for my diet?

Speaker- Dr. Stewart: A diet for PAD should be one that tries to reduce the risk factors for cardiovascular disease. This would start with a plan to lose weight, if needed, and to control diabetes, if needed. There should be a good balance of fat, carbs, and protein. Recent data suggests that a low-carb diet may be very beneficial for weight loss and to reduce risk factors.

Linda Jones: Are there supplements or medicines that can reduce the risk of the ministrokes that lead to vascular dementia? For example, if the patient does not have high BP.

Speaker- Dr. Stewart: I am unaware of any research showing that supplements can reduce the risk of vascular dementia. In general, a diet like the one mentioned above is recommended for most of the vascular disease.

Kate: What is the difference between PVD and PAD?

Speaker- Dr. Stewart: The term PVD stands for peripheral vascular disease. It is more of a general term and could include diseases of both the arteries and veins. PAD, or peripheral arterial disease, is more specific, and refers to those problems affecting the arteries.

Moderator- VDF: This next question was also e-mailed to us ahead of time: If I have PAD and have a sore or wound on my foot that won't heal, should I be worried?

Speaker- Dr. Stewart: A non-healing sore, wound, or ulcer is of great concern. The risk of an open wound is infection, which may be difficult to treat when there is limited blood supply to the foot. If not treated, the infection could affect bones, and there is a real risk of losing a limb.

Kate: I have PAD and I have kids. Should they be tested/worried about genetic pre-disposition?

Speaker- Dr. Stewart: Vascular disease often runs in families. There is probably a genetic component but also an environmental component. Therefore, parents should make sure that their kids stay active; avoid being overweight, and get periodic measurement of blood chemistries to monitor for early signs of high cholesterol and blood sugar. Also, they should have their BP checked. And most, important, they should not be allowed to smoke.

Moderator- VDF: This next question was also e-mailed to us had of time: Is there a difference between PAD and critical limb ischemia?

Speaker- Dr. Stewart: Critical limb ischemia is a severe form of PAD. In this condition, the person will experience pain at rest, there may be non-healing wounds, and gangrene. At this stage of the disease, a surgical intervention is usually required or the person may lose the limb.

Moderator- VDF: This next question was also e-mailed to us ahead of time: If I have diabetes, do I have to worry about PAD?

Speaker- Dr. Stewart: Smoking and diabetes are the 2 strongest risk factors for developing PAD. Diabetes damages the blood vessels, and therefore, is likely to cause a problem in the legs, heart, and brain.

Kate: I work in a building where people smoke outside a lot. Should I be worried about second hand smoke with PAD?

Speaker- Dr. Stewart: Second hand smoke has been shown over and over again to be a risk factor for health problems, including vascular disease. Stay away from smokers, either inside or outside.

Linda Jones: OK, I understand supplements don't help, but what about medicines? For example, is aspirin of any benefit or any Rx medicines?

Speaker- Dr. Stewart: Depending on the individual's risk factor status, there are several medicines that can be used to control them. These include aspirin, and medicines for lowering cholesterol and blood pressure, and for managing diabetes.

Moderator- VDF: This next question also came to us ahead of time by e-mail: I read that the number of people with PAD is increasing. Why is that?

Speaker- Dr. Stewart: There was new research presented at the American Heart Association Meeting in Nov 2007 that shows that PAD prevalence continues to grow. We discuss this study on our HealthCast Episode 23 which may be found on VDF’s Web site. The causes have to do with more people living to an older age, and also due to more obesity, more diabetes, more hypertension, less physical activity, and too many people also continue to smoke. Unless we get some of the problems under control, the problem might get worse yet.

Larry: I am 54 and lift weights regularly. Over the last 10 years I have noticed the muscle definition in my calves has changed. They seem skinnier, no matter what I do. Is this an age related thing?

Speaker- Dr. Stewart: There will be a loss of muscle mass with age. However, weight lifting is the best way to keep that loss to a minimum. Keep up the good work.

Kate: Is PAD the only thing that can cause chronic leg pain?

Speaker- Dr. Stewart: Many conditions can cause leg pain, for example, a herniated back disc, this why it is important to see a doctor to get a diagnosis. As discussed before, the ABI test, which measures BP in the arms and legs, is a good test for making the diagnosis. It is inexpensive, gives an immediate answer, and is painless.

Moderator- VDF: Thank you all for your participation today and many thanks to Dr. Stewart for donating his time to answer your questions. We wish you all a good day and a very Happy Thanksgiving! Thank you again for support the Vascular Disease Foundation!


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.