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Editorials | Article | Middle | Oped — Health

EDITORIALS

CWG shadow-boxing
Not the time to settle political scores
T
HE blame game on the Commonwealth Games scam has assumed new dimensions with Sports Minister Ajay Maken pointing out that it was the NDA government at the Centre that had facilitated the appointment of Suresh Kalmadi as the chairman of the Games Organising Committee and that by signing the Host City contract with the CWG Federation rather than leaving this task to the Delhi government, it was the source of all the problems that followed later.

Mansa farmers mistreated
Punjab needs effective land policy
I
F the Mansa farmers’ agitation against the Punjab government’s forcible land acquisition for a private thermal power plant has turned violent and threatens to spread, it is because of the use of excessive force and lack of a comprehensive and transparent land policy. The dispute is over compensation. Farmers claim that the Rs 23.77 lakh per acre being offered is below the market price.


EARLIER STORIES



Maritime blues
Breach in security of serious concern
T
HE sudden discovery earlier this week of a 1,000-tonne merchant ship that ran aground undetected on Mumbai’s Juhu beach has exposed chinks in India’s maritime security. The Panama-registered ship, MT Pavit, which had been abandoned by its crew and presumed sunk managed to not only stay afloat but also get past a three-tier maritime security ring and land undetected at a premier beach of the metropolis after drifting over a considerable distance in the Arabian Sea.
ARTICLE

Of India’s Pakistan policy
Is Delhi chasing its own tail?
by Zorawar Daulet Singh
T
HE recent Foreign Ministers’ dialogue has apparently restored the trajectory of engagement that has been periodically battered by the reality of India-Pakistan relations over the past decade. Pakistan’s Foreign Minister declared that both sides desired to make the dialogue an “uninterrupted and uninterruptible process”. India’s Foreign Minister declared the visit as “a new era of bilateral cooperation”.

MIDDLE

Remembering Parmar
by Chander P. Bakshi
I
was transforming myself from rural-teenage into urban-teenage! One day, dressing for school I misplaced my belt for tightening knickers, so I snatched the substitute from my ‘pajama’ immediately and finished the job after camouflaging the string with my shirt. While running down the stairs of our rented house, I noticed a man sitting on a broken wooden box with his legs crossed swinging like a pendulum.

OPED  — HEALTH

Simple measures should be taken from an early stage in life to prevent a crippling and even life-threatening condition like vascular disease from developing
Be kind to your heart
Harinder Singh Bedi
V
ASCULAR disease is a major health problem in India. One in 20 people over 50 years of age have it. The total number of cases are over 42 million. More than half of those affected may not even know about the disease till it is too late. Vascular disease is not just "poor circulation." It comes in various forms: peripheral arterial disease affects the arteries taking blood to the arms and the legs, carotid artery disease affects the arteries taking blood to the brain, and renal artery disease limits the blood flow to the kidneys causing high blood pressure or renal failure.





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CWG shadow-boxing
Not the time to settle political scores

THE blame game on the Commonwealth Games scam has assumed new dimensions with Sports Minister Ajay Maken pointing out that it was the NDA government at the Centre that had facilitated the appointment of Suresh Kalmadi as the chairman of the Games Organising Committee and that by signing the Host City contract with the CWG Federation rather than leaving this task to the Delhi government, it was the source of all the problems that followed later. The BJP on its part had been pointing a finger at the UPA for disregarding the advice of two erstwhile sports ministers — Sunil Dutt and P.P.S. Gill — not to appoint Kalmadi. It is obsessed with not getting at the truth but to make political capital out of the scam. As for the Comptroller and Auditor-General (CAG) of India, its leaked report is believed to have blamed the PMO for the appointment.

The real issue, however, should be not who chose Kalmadi but how systemic failures led to such misappropriation of public funds and what steps can be taken to not only bring all culprits to book but ensure that such things do not happen in future. Clearly, though Suresh Kalmadi should not but be called to account, all others responsible for defrauding the exchequer must be unmasked and punished so that there is an effective deterrent for the future. At the same time there are procedural lapses that need to be gone into. It is all very well for the two principal parties to quibble over an appointment but what about the fact that work on the infrastructure for the Games proceeded at snail’s pace while costs escalated and the international body sounded the danger bugle.

It would be a tragedy indeed if the whole issue of irregularities and procedural delays gets bogged down in political shadow-boxing. The CAG report is yet to be publicly released, but already Delhi Chief Minister Sheila Dikshit is rubbishing its observations. The CAG report is believed to have slammed all civic agencies which were working for the Commonwealth Games project besides many other individuals and bodies. Action must follow swiftly and decisively without the motivation to settle political scores. The onus is indeed on the UPA government to act.

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Mansa farmers mistreated
Punjab needs effective land policy

IF the Mansa farmers’ agitation against the Punjab government’s forcible land acquisition for a private thermal power plant has turned violent and threatens to spread, it is because of the use of excessive force and lack of a comprehensive and transparent land policy. The dispute is over compensation. Farmers claim that the Rs 23.77 lakh per acre being offered is below the market price. Going by the Centre’s draft land Bill, farmers in rural areas should get six times the market price of land. It says 80 per cent land-owners must give their consent and the government can forcibly acquire only the remaining 20 per cent for a public purpose.

Punjab’s own land policy is inadequate. Under the policy the government designates “land aggregators” who buy land from farmers and sell it to the government for 2 per cent commission. The Congress has already trashed the policy. If there had been no protests earlier over land acquisitions in Punjab it is because the government has been doling out — rather arbitrarily — liberal compensation to farmers. It paid Rs 1.5 crore per acre at Mohali for land taken over for airport expansion. The land being close to the Air Force station had a market rate of Rs 50-60 lakh per acre. Mullanpur farmers also got Rs 1.2 crore to Rs 1.5 crore per acre depending on the location of the land. This was beyond farmers’ expectations.

The Mansa farmers have been given a raw deal if the price offered to them is compared with the rates given elsewhere in the state. For a private thermal plant at Rajpura the price paid was Rs 35 lakh per acre. For the government power plant at Gidderbaha, the constituency represented by former Finance Minister Manpreet Singh Badal, farmers got Rs 20-28 lakh per acre. Much of the land was water-logged and the then power board had objected to the high price paid. The government abandoned the Mohali-Phagwara highway when some farmers objected to the land acquisition. In this backdrop the Mansa farmers have been unfairly dealt with.

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Maritime blues
Breach in security of serious concern

THE sudden discovery earlier this week of a 1,000-tonne merchant ship that ran aground undetected on Mumbai’s Juhu beach has exposed chinks in India’s maritime security. The Panama-registered ship, MT Pavit, which had been abandoned by its crew and presumed sunk managed to not only stay afloat but also get past a three-tier maritime security ring and land undetected at a premier beach of the metropolis after drifting over a considerable distance in the Arabian Sea.

This is not a one-off incident. Only six weeks ago, another cargo vessel, MV Wisdom, had similarly run aground in Juhu undetected. The fact that a repeat of the same has occurred in the country’s financial capital, which in November 2008 witnessed one of the country’s most sensational carnages inflicted by a group of Pakistani terrorists who landed in that city by sea, reflects poorly on India’s maritime security system. Mumbaikars and the country alike would have expected that the security apparatus would be operating on peak efficiency, considering that Mumbai suffered a bomb blast only three weeks ago. Instead, the land that boasts of producing the Arthashastra, a treatise on statecraft, military strategy and economic policy, and the Bhagavad Gita, a treatise in Just War (along with spiritual teachings), has maintained a remarkable consistency in not learning from past mistakes and permitting history to repeat itself. The government launched Operation Swan that involved patrolling coastal waters off the coast of Maharashtra and Gujarat soon after the March 1993 serial bomb blasts in Mumbai that had been set off by terrorists who smuggled explosives by sea. In 2005-06, after the Kargil War, the government launched a comprehensive coastal security scheme. Yet, this did not prevent the occurrence of the November 2008 terror attacks. Subsequent maritime security measures have similarly not been enough to enable India’s maritime security system to detect two large cargo ships in quick succession.

It is indeed becoming difficult to determine what is more scary – terrorist attacks or the seeming incompetence of the country’s maritime security system. Both the Centre and the governments of coastal states, particularly Maharashtra, need to treat this ‘incursion’ as a wake-up call and get their act together. Ignoring the incident is not a luxury India can afford.

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Thought for the Day

Vulgarity in a king flatters the majority of the nation.

— George Bernard Shaw

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Of India’s Pakistan policy
Is Delhi chasing its own tail?
by Zorawar Daulet Singh

THE recent Foreign Ministers’ dialogue has apparently restored the trajectory of engagement that has been periodically battered by the reality of India-Pakistan relations over the past decade. Pakistan’s Foreign Minister declared that both sides desired to make the dialogue an “uninterrupted and uninterruptible process”. India’s Foreign Minister declared the visit as “a new era of bilateral cooperation”. Clearly, the national mood has changed, and even the fiercest critics of an engagement with Pakistan have conceded that bilateral interactions cannot remain frozen. Even the political opposition is now positioning itself as the pioneers of India’s diplomatic breakthrough with Pakistan!

The resumption of dialogue is an admission that India’s principled stand on terrorism – “no talks before the Pakistani perpetrators of 26/11 are brought to justice” – has lost its steam. Of course, this strategic and elite rethink is shaped by geopolitics. The Indian government is acutely sensitive about the prevailing geopolitical situation vis-à-vis American dilemmas in Afghanistan and Pakistan, and is unwilling to rock the boat. Talks with Pakistan should be viewed in that backdrop – Delhi will do nothing to undermine the civilian façade in Islamabad and appears content in going through the motions of a dialogue.

Such a backdrop has made it easy for Delhi to rubbish its own post-26/11 Pakistan posture as a long and fruitless sulk. The American Secretary of State’s recent visit and the re-elevation of a grand vision for India’s impending rise has made re-engaging our troubled neighbour easier. Plainly put, Washington’s reassurance to Delhi has spurred the latter to reassure Pakistan.

This is an apt moment to step back and deconstruct India’s Pakistan policy. Over the past decade, three distinct prescriptions have been proffered for a Pakistan policy. First, engage on the premise that Pakistan will transform. Second, adopt a posture of benign neglect or, to put it more bluntly, let Pakistan “stew in its own juice”. Third, actively implement the policies of containment and covert insurrection as a quid pro quo for Pakistan’s diabolical proxy war.

Each prescription is based on fundamental assumptions about the underlying power structure and strategic calculus that drives Pakistani actors. Engagement is premised on the belief that the civilian and military establishments form a genuine cleavage and only if India would offer sustenance and legitimacy to the former, Rawalpindi would ultimately become either subordinated to a liberal modernising civilian leadership or at least face a countervailing power centre. The second and third groups rebut such a vision of restructuring the civil-military hierarchy in Pakistan as a fool’s errand because the civilian and military elite are two sides of the same coin and share a common legacy and legitimacy to power. In this view, the military underwrites the feudal-Punjabi monopoly, and a decline of the GHQ will also mean the decline of the old feudal order that feeds the present civilian leadership.

In more recent years, the first group has discovered a new rationale for engagement: the present Pakistani order, however, unpleasant is preferable to the radical Islamists that could follow. This is rebutted with the argument that the Islamists are nurtured and sustained by the status quo actors in Pakistan as part of a well-documented strategy, and radicalism would lose its resonance in a truly democratic Pakistan.

Finally, the first group reinforces its argument on the notion that there is no alternative to talking in an age where extensive use of force has been ruled out in a nuclearised subcontinent. This again finds a counter-view: talking versus an outright war is a false binary choice deliberately contrived to suppress the several nuanced and complex postures that can be adopted in between. Here India’s doctrinal and strategic inflexibility has arguably enabled Pakistan to overplay its nuclear deterrent.

To be sure, the most optimal policy should be informed by some or all of these perspectives. Using the arguments of the first group, India’s actual policy is once again being driven by an impulse for engagement for its own sake. Ironically, both India and Pakistan appear content with the present mode of engagement. Neither expect to give or receive major concessions. The political flux in both countries circumscribes any radical overhaul in bilateral relations.

And then there are some aspects of Indian policy that are truly baffling. Delhi was presented with an extraordinary window of opportunity in the 2000s where Pakistan’s Afghan pre-occupations should have made shoring up India’s position on Kashmir a priority. Inexplicably, India expended an extraordinary amount of diplomatic resources on Afghanistan while barely providing strategic attention to a core interest on its own frontiers.

Today, India is in a situation where it has neither attained a sustainable position in Afghanistan that can hold its own after an American drawdown nor has it shored up its strategic advantage on Kashmir. It is now being suggested that engagement with Pakistan can help India raise its profile in Afghanistan. In other words, putting the cart before the horse!

The fundamental problem in India’s Pakistan policy is that it is a series of tactical events masquerading as a strategy. Pakistan’s policy remains driven by real tactical incentives where multidimensional security dilemmas such as pressure on its western frontiers and domestic instability have made it rational for Rawalpindi and Islamabad to pursue a détente with India. Pakistan’s overall grand strategy of cultivating a permanent hostility with India, however, cannot change in the present power configuration within Pakistan. The feudal-military nexus views genuine democratisation as accelerating the diminishment and perhaps denouement of the present Punjabi elite. And the India “threat” without and Islamisation within is seen as the only assured means to preserve the present power monopoly and stave off centrifugal pressures. India’s engagement then, ironically, legitimises and offers breathing space to the very actors that the policy is presumably intended to ultimately subdue – the feudal-military elite.

India has never seriously introspected on what it truly seeks within Pakistan. Does it seek a perpetuation of a farcical democratic status quo with the feudal-military superstructure at its apex even if this configuration of power produces a chaotic equilibrium in India-Pakistan relations with the occasional recourse to Washington’s good offices? Or does India seek a sincere democratisation in a federal multi-ethnic structure of power even if that weakens the present incumbents? Whether by design or sheer drift, India has been pursuing the former conservative path for the past decade.

Perhaps only a stronger and more stable India can contemplate a strategic future for Pakistan that envisages a truly transformational subcontinent. Until then, India will be chasing its own tail on Pakistan.

The writer is a Research Fellow at the Centre for Policy Alternatives.

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Remembering Parmar
by Chander P. Bakshi

I was transforming myself from rural-teenage into urban-teenage! One day, dressing for school I misplaced my belt for tightening knickers, so I snatched the substitute from my ‘pajama’ immediately and finished the job after camouflaging the string with my shirt. While running down the stairs of our rented house, I noticed a man sitting on a broken wooden box with his legs crossed swinging like a pendulum.

When I entered the narrow stinking street leading to school, I again noticed a number of policemen roaming to and fro with their sticks.

On reaching the school I learnt that Chief Minister Yashwant Singh Parmar had visited our premises! Again this information baffled me as my general awareness was confined to the level of a headmaster.

When I returned home, our landlord commonly known as ‘Babaji’ called me. He narrated the whole story to me. How he went knowingly to the ‘mock morning puja’ and kept ‘Yaswant’ in waiting for half an hour outside and only then embraced him. Babaji was testing patience and commitment to relationship whether he was the same Yaswant after occupying the chair of Chief Minister. He further narrated how Yaswant from baby steps, to walking, and then to running targeted the goal.

The second incident was that of my father who happened to be the Headmaster of the school. One day, a man in khaki uniform came to our house informing us that the Chief Minister had desired us to meet him that evening in the circuit house. Again, panic prevailed in the house. Instead, the Chief Minister congratulated my father with a pat on his back. The Chief Minister wanted to know why the teachers with their leader were not coming to meet him for the last six months which was a common feature earlier. My father told him that he had adjusted all their demands within the school timetable. For example, their leader was in the habit of snoring after lunch break so a vacant period was adjusted for him after the break. The Chief Minister appreciated it and remarked that he also did not want people coming to him for trivial issues.

The third incident was that of my uncle. He was a good athlete recognized as

the ‘Milkha Singh of Police Department’. My uncle showered flowers on the car of the Chief Minister and for that act he was placed under suspension by the department. After some time, my uncle managed to meet the Chief Minister in his official residence. He narrated that he had not hurled stones on the car, rather showered flowers. Laughing loudly, the Chief Minister directed the department to reinstate him immediately.

Dr. Y.S. Parmar, the architect of Himachal Pradesh, believed that word of mouth was more powerful than publicity. He never interfered with the system and kept his mind free for “Thinking” about the steady and all-time high progress of the state.

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OPED — HEALTH

Simple measures should be taken from an early stage in life to prevent a crippling and even life-threatening condition like vascular disease from developing

Be kind to your heart
Harinder Singh Bedi

Harinder Singh BediVASCULAR disease is a major health problem in India. One in 20 people over 50 years of age have it. The total number of cases are over 42 million. More than half of those affected may not even know about the disease till it is too late.

Vascular disease is not just "poor circulation." It comes in various forms: peripheral arterial disease affects the arteries taking blood to the arms and the legs, carotid artery disease affects the arteries taking blood to the brain, and renal artery disease limits the blood flow to the kidneys causing high blood pressure or renal failure.

Arterial disease is most often caused by atherosclerosis (hardening of the arteries). When atherosclerosis develops, the normally smooth linings of the arteries become narrow and rough from the buildup of plaque, which is made up of cholesterol and calcium deposits.

The severity of the blockage can be assessed by a diligent history taking a good clinical examination followed by noninvasive tests.

Thinkstockphotos/Getty Images
Thinkstockphotos/Getty Images

Noninvasive Tests

A number of noninvasive tests are available to determine the presence and/or extent of vascular disease. In fact August is International Vascular Month and various camps have been organized to detect and treat patients of vascular disease.

  • Ankle-Brachial Index - 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 comparison of the two numbers determines if the patient has peripheral vascular disease and if more tests are needed.
  • Vascular Ultrasound - This simple, noninvasive test is very important to evaluate the arteries and veins and is the first choice for evaluation.
  • Computed Tomography Angiography - A CT scan is a common radiologic test, which can be tuned to study the blood vessels. This test is very important for assessing aneurysms of the aorta and other vessels.
  • Magnetic Resonance Angiography - Magnetic resonance imaging, commonly known as MRI, makes images of the body using a very strong magnet. The images can be focused to provide images of the arteries.

The German Epidemiological Trial on Ankle-Brachial Index (getABI) concluded that peripheral artery disease (PVD) should be treated in the same way as patients with heart disease, as PVD patients are currently undertreated. GetABI showed that PVD patients have a substantially increased risk of death-dying, on 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.

Invasive Tests

Depending on the results of the noninvasive tests that have been performed, your physicians may order angiograms for further evaluation of the disease.

  • Angiography - The most accurate test of the blood vessels is an angiogram. In this test, a small needle is put through the skin and into an artery at the top of the leg. A small plastic tube is then slid into the arterial system. X-ray contrast is then injected into the arterial system so that X-ray images of the vessels can be taken. During angiography, additional images can be obtained, using intravascular ultrasound (IVUS). A small ultrasound device is advanced into the arterial or venous system. The IVUS is useful for measuring blood vessels and for obtaining images of atherosclerotic plaque and other abnormalities.

CT Angiography : This is a simple noninvasive test. The CT machines today are much more sophisticated and can give results as good or better than the conventional angiography with no injection into the arteries.

Treatment Options

Individual treatment options depend on a number of factors that will be explained by the physician. One size does not fit all in managing the disease. Often a combination of risk reduction, medicines, less invasive treatment options and surgery provides the patient with the best chance for a good outcome.

Risk Factor Modification / Management: For patients with mild or early stages of vascular disease, lifestyle modification and medical management of risk factors can slow down the progression of disease to the point that the individual may never need surgery or endovascular intervention.

  • Lifestyle changes include
  • Stopping smoking - MOST IMPORTANT
  • Managing diabetes, high blood pressure and high cholesterol levels
  • Regular graded exercise - including yoga
  • Following a heart healthy diet.

In addition, anti-platelet medications (Aspirin or Plavix), anti-hypertensive medications, blood vessel dilators and lipid-lowering medications all may be used in the medical management of vascular disease.

If the cause is an acute blood clot it may respond to medicines which dissolve the clot. This means the use of thrombolytics (clot busters) or a minor surgical procedure - embolectomy - to remove the clot.

  • Endovascular Interventions - These procedures are minimally invasive and require only a small puncture in the groin, very similar to Angiography. A balloon is inflated at the blockage and a spring (stent) is used to prop the artery open. Now vascular surgeons are getting more skilled at tackling even major disorders eg abdominal aortic aneurysms with minimally invasive or noninvasive procedures with success.

Surgical options

Surgery is a time tested and reliable option for most vascular disorders:

  • Vascular bypass - This procedure uses synthetic material or a portion of a person's own vein to route blood around a blockage in an artery. This is the most common surgical technique used in treating peripheral artery disease. The bypass material is sewn into the blood vessel above the blockage and then sewn below the blockage. This creates a new pathway for the blood to travel through. Bypass can be used to treat blockages in the legs, kidney arteries and aorta. A world first surgery documented in the Limca Book of World Records was invented by the author to prevent gangrene of the leg by transplanting an artery from the hand.
  • Endarterectomy - This is a procedure in which the blood vessel is opened and plaque is removed or scraped out of the artery to restore blood flow through the vessel. The artery then is closed with a patch that makes the vessel wider. This works best for narrow areas or complete blockages of an artery. This procedure is used to treat blockages in the carotid arteries, which feed blood to the brain, and is sometimes used for other blood vessels in the upper leg.
  • Aneurysmectomy - This involves placing graft material in an aneurysm so that blood flows through the graft. The aneurysm collapses against the wall of the graft, and is no longer at risk for rupture. This is used for treatment of any type of aneurysm.

Preventing PVD

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) - help to prevent the progression of the blockage and encourages the development of collaterals.

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 former of tobacco use is mandatory if a permanent solution is to be got.

In diabetes the risk of narrowing of the arteries by a build-up of fat and cholesterol (atherosclerosis) is much 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.

Dr Bedi is Head, Cardio-Vascular Endovascular & Thoracic Surgery, at the Christian Medical College & Hospital, Ludhiana.

Risk Factors

Cigarette smoking is the No 1 risk factor for developing vascular disease

  • Obesity
  • Diabetes mellitus
  • High cholesterol and lipids
  • Heart disease
  • High-stress lifestyle
  • Older than age 50
  • Sedentary lifestyle
  • High blood pressure

symptoms

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

Peripheral Artery Disease:

  • Leg pain with exercise known as claudication
  • Leg swelling
  • Weakness or tiredness in the legs
  • Sores on feet or legs that won't heal

Carotid Artery Disease:

  • Temporary loss of vision in one eye, or blurred or double vision
  • Confusion
  • Loss of balance or coordination
  • Numbness or weakness on one side of the body
  • Slurred speech or difficulty speaking
  • Change in ability to use arms and legs
  • Stroke

Abdominal Aortic Aneurysm:

  • Often no symptoms
  • Sudden onset of abdominal or back pain

Renal Artery Disease:

  • High blood pressure (hypertension)
  • Acute renal (kidney) failure

Mesenteric Artery Disease:

  • Abdominal pain, especially after eating
  • Unwanted weight loss

Venous disease:

  • Leg swelling
  • Sores on lower legs that do not heal
  • Leg pain

Dilated Varicose leg veins

Are you at risk?

Take this short quiz to see if you could be at risk for peripheral vascular disease (PVD).

  • Are you age 50 or older?

Yes No

  • Do you smoke?

Yes No

  • Do you have diabetes?

Yes No

  • Do you have high blood pressure?

Yes No

  • Do you have high cholesterol?

Yes No

  • Do you have a family history of heart disease or vascular (blood vessel) disease?

Yes No

  • Are you overweight?

Yes No

  • Are you sedentary with little or no exercise?

Yes No

If you answered yes to even one of these questions, you could be at risk for PVD. A simple checkup by your doctor should be done.

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