Peripheral vascular disease: a preventable killer
Dr H. S. Bedi

Many people who find walking painful may believe that it is related to arthritis or is a natural effect of aging. Quite often it is the result of the blockage of the arteries of the leg due to atherosclerosis called peripheral vascular disease (PVD).

PVD affects about one in 20 people over the age of 50 (over 10 million people). More than half of them have symptoms but initially many dismiss these as related to the normal aging process while only half of those with symptoms get proper diagnosis and treatment. People with early PVD will be showing no symptom at rest, but on walking they will get pain in their calf muscles, thighs or buttocks. This is known as intermittent claudication. It is usually severe enough to make the person stop walking, leading to relief from the pain.

As the blockage progresses, the claudication distance reduces so that even a short walk will precipitate the pain. Other symptoms may include numbness, tingling, weakness, burning or aching in the leg. There may be a cooling or colour change along with the loss of hair on the legs. Sometimes there may be no obvious early symptoms. This was seen in an otherwise very active lady golfer, who ended up with amputation as her first symptom was gangrene. With the progression of the disease, there may be ulceration, bluish discoloration and even blackening of the toes or foot (gangrene).

The severity of the blockage can be assessed by a diligent history taking a good clinical examination followed by non-invasive tests. The most common test for PVD is the measurement of blood pressure with a special ultrasound stethoscope and machine at the ankle and its comparison with that at the elbow — the ankle-brachial index (ABI) . This is a painless and fairly sensitive test which gives some idea about the severity of the disease. It also is useful in following the patient’s progress after medication or surgery. The German Epidemiological Trial on Ankle-Brachial Index (getABI) concluded that PVD should be treated in the same way as patients with heart disease, as PVD patients are currently under-treated. GetABI showed that PVD patients have a substantially increased risk of death —dying, on an average, 10 years earlier than their peers — and that asymptomatic PVD patients are as much at risk as symptomatic ones, a vital fact that was not previously appreciated.

Family physicians can identify high-risk patients and initiate and maintain effective treatment in this large group. A huge number of lives can be saved if patients with atherosclerosis are identified with ABI and treated in a timely manner.

In the early stages, the use of dietary modifications — basically, a low fat vegetarian diet, weight reduction (if overweight), graded exercise, along with the use of blood thinners, vessel dilators and cholesterol reducing drugs (statins) — helps to prevent the progression of the blockage.

Regular exercise is the most consistently effective treatment for PVD. Exercise programmes include simple walking regimens, leg exercises and treadmill exercises under expert supervision three or four times a week. Avoidance of smoking and all other forms of tobacco use is mandatory if a permanent solution is to be got.

In the case of diabetics, the risk of narrowing of the arteries by a build-up of fat and cholesterol (atherosclerosis) is more than in non-diabetics. The patient must inspect his feet between toes and pressure areas using a mirror regularly. He must wash his feet daily with soap and lukewarm water. He must avoid tight-fitting shoes and very hot water, hot-water bottles or chemicals (to treat corns) on the feet.

Thus, simple measures should be taken from an early stage in life to prevent a crippling and even life-threatening condition from developing.

Symptoms for different vascular diseases which are otherwise preventable:

(Patients with any of these disorders may have no symptoms):

l Peripheral artery disease

l Leg pain with exercise

l Leg swelling

l Weakness or tiredness in the legs

l Sores on the feet or legs that won’t heal

l Carotid artery disease

l Temporary loss of vision in one eye, or blurred or double vision

l Confusion

l Loss of balance or coordination

l Numbness or weakness on one side of the body

l Slurred speech or difficulty in speaking

l Change in the ability to use arms and legs

l Abdominal aortic aneurysm

How can you lower your own risk factors?

Stop smoking

Maintain your management of diabetes — if you have the disease — with diet and medication

Exercise regularly

Maintain a healthy diet (heart-healthy, low-sodium)

Tell your doctor if you have any of the symptoms of vascular disease.

Control your blood pressure with diet or medications

Lower blood cholesterol levels, if elevated, with diet or medication

The writer is Head, Cardio-Vascular & Thoracic Surgery, Christian Medical College & Hospital, Ludhiana. Email: drhsbedicmc@gmail.com

Hip pain — get the cause treated
Dr Ravinder Chadha

Hip pain is a widespread affliction, which can affect everyone from infants to the elderly. Hip problems are more common than widely realised and not given much attention as it happens in the case of knee pain. Knee pain due to arthritis is very common whereas hip arthritis occurs in rare cases.

The hip is a ball-and-socket joint and strong enough to take the load of the body whereas the knee is a hinge joint prone to injuries of the cartilage and ligaments with high-impact activities, etc.

Whenever a person complains of hip pain, he probably means that he has pain either in the buttocks or in the upper lateral thigh or in the groin. There is no doubt that the disease of the hip can cause pain in these areas but there can also be a referred pain from the back.

Symptoms

l Inability to sit cross-legged can be due to some hip problem.

l Pain which is worse in the morning and improves during the day may be caused by hip arthritis.

l  Pain that radiates to the leg from the hip can be due to a lower back problem.

l  Pain with movement is most often caused by a muscle injury or bursitis.

l  Pain during weight-bearing activity increases when a person stands or walks, forcing him to limp. This type of pain is usually caused due to the hip joints involvement.

The common causes of hip pain are due to lower back problems, fractures, arthritis and insufficient blood flow to the hip.

l  Hip fractures become more common as people age because falls are more likely and bones become less dense. People with osteoporosis can get a fracture from simple, everyday activities, not just a dramatic fall or injury.

l  Hip arthritis affects young and middle-aged persons and is classified as primary and secondary osteoarthritis.

- Primary osteoarthritis is an age-related wear and tear problem.

- Secondary osteoarthritis occurs at a younger age and is more common. Rheumatoid arthritis, traumatic arthritis and connective tissue disorders, etc, lead to secondary osteoarthritis.

- Post-traumatic arthritis occurs after a severe injury to the hip. Fractures of the femur or socket (acetabulum) can lead to arthritis after inadequate treatment.

Treatment

Try to avoid the activities that aggravate pain.

As pain decreases, gradually begin to exercise. Swimming may be a good option because it stretches the muscles and builds good muscle tone without straining the hip joint.

Prevention

l  Avoid falls.

l  Try to avoid the activities that aggravate pain like running on an uneven surface.

l  Sleep on your non-painful side with a pillow between the legs.

l  Cane prevents the pressure on the hip joint. The more the pressure on the cane, the less shall be the pressure on the affected joint.

Without the cane, the resultant force across the hip is about three times the body weight.

Handle of the cane should be at the level of the hip pocket.

While using the cane, the elbow should be flexed 20-30 degrees.

Cane should be held by an opposite hand.

Exercises

Warm up before exercising and cool down afterward. When pain improves, slowly and carefully resume walking.

Lying on the back with legs straight and toes pointed upwards. Rotate the toes inward and then outwards 10 times.

Lying sideways, raise the upper leg upwards. Stay for a count of five and return back. Repeat 10 times.

Support yourself on your elbows and knees, with hands together in front. With your back straight, raise one bent leg up in the air. Return back and repeat it 10 times.

Stand straight with your hands on the wall. Bend one leg to 90 degrees backwards and push the sole of your foot away from you. Repeat five times.

Lie flat on your back with your heels up on a bench/chair, knees bent at 90 degrees and hands at the sides. Raise the pelvis off the floor by squeezing the buttocks until your body is straight from the knees to the chest. Repeat it five times.

Those who don’t get relief from conservative treatment are advised hip replacement surgery.

The writer is a former doctor/physiotherapist, Indian Cricket Team. E-mail:

chadha_r2003@yahoo.co.in

Health Notes
How to stay away from gym germs

Washington: From yoga mats to exercise machines and in many other spots, gyms are a breeding ground for germs. Hence, certain precautions are necessary to steer clear of germs, say experts. On “The Early Show on Saturday Morning”, Dr Kavita Mariwala discussed tips one can try to keep from getting more than you bargain for during your workout. She said the best thing one could do was wash your hands frequently to stay away from any infection, reports CBS News. Also, before grabbing any mat, take a quick look at it and wipe it down with anti-bacterial wipes, especially the part you expect to be lying on, and let it dry. She also said it’s best to go with anti-microbial instead of antibacterial soaps, because one is hitting all classes of germs: fungal, bacterial and viral. — ANI

The latest diet fad: weight loss patches

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Chronic back pain: little adversity is beneficial

Washington: A new study has revealed that for people with chronic back pain, having a little adversity in life can be protective and beneficial. These individuals experience less physical impairment and spend less time in doctor's offices or health clinics, said the study's author Mark Seery, of University of Buffalo. He emphasised that the key to the benefit is the experience of "some" prior adverse events as opposed to many or none at all. "This study of 396 adults with chronic back pain (CBP) found that those with some lifetime adversity reported less physical impairment, disability and heavy utilisation of health care than those who had experienced either no adversity or a high level of adversity," explained Seery. — ANI

Go at your own pace to be stronger!

Washington: A particular strength training technique that allows athletes to increase strength by progressing at their own pace provides better results than standard techniques in which resistance is steadily increased. The scientists have found that the autoregulatory progressive resistance exercise (APRE) is more beneficial than the standard ones. "For the strength coach or practitioner who must demonstrate the greatest strength and strength-endurance gains during short-duration training cycles, APRE training is effective," said J. Bryan Mann of University of Missouri. — ANI