Learning From the Past: The Differences in PAD Based on Gender Women smiling Modern Vascular

Learning From the Past: Differences in PAD Based on Gender

By Kirstin Rizk

Heart disease is the leading cause of death worldwide[1] and has been the leading cause of death in the U.S. for over a century.[2] Originally, it was largely thought of as a man’s disease, and researchers did not consider if it might affect women differently from men. Ultimately, it was identified that “Women had an increased risk of hospital death, reinfarction, heart failure, stroke, and transfusion,” yet, were less likely to receive lifesaving and preventative treatment.2 

Now that the medical community is aware of the differences in the ways that heart disease and heart attacks present in women, progress is being made to ensure that women are aware of their risk and treatment is equal.

In recent years, progressive physicians have been looking at peripheral artery disease (PAD) and wondering if history is repeating itself.

Dr. Paul Rochon, managing physician at Modern Vascular in Denver, stated, “PAD has traditionally been identified as a male-dominant disease; however, recent population trends and studies in PAD suggest that women are affected at least as often as men.”[3]

Dr. Rochon and coauthor Dr. Kristofer Schramm did a review of existing research on this topic to see if they could form some conclusions from the data when looked at all together. Below, we will review some of the differences between PAD in men and women, and some key takeaways.

1. While risk of PAD increases with age, this factor seems to have an even greater impact on women. Women over 85 were 12% more likely to have PAD than men over 85.[4]

The Takeaway: Everyone over 55 should be screened annually for PAD, but women should take extra care to get their annual screening.

2. Women are more likely to have PAD without any symptoms.[5]In fact, up to 63% of elderly females with PAD demonstrated no leg symptoms during exercise.[6], [7]

The Takeaway: Even if you don’t have leg pain during exercise, you may be at a higher risk for heart attack or stroke due to PAD that you can’t feel.

3. Yet, women are twice as likely to have unusual leg symptoms (other than leg pain) when exercising.6, [8]

The Takeaway: Much like with heart attacks, PAD presents differently in men and women. For this reason, it is harder for patients and physicians who don’t specialize in PAD to recognize PAD in women.

Additionally, treatment of PAD and related outcomes differ for women and men:

1. Women are significantly less likely than men to receive a surgical revascularization procedure.[9]

The takeaway: don’t be afraid to advocate for your health.

2. In patients with critical limb ischemia (a severe, limb-threatening form of PAD) who were treated with open surgery/peripheral bypass, women have a higher incidence of wound complications, limb loss, and mortality than men.[10]

The Takeaway: Open surgery sometimes is necessary, but should be avoided if possible to save the limb in other ways.

3. Women showed higher rates of improved circulation in the legs from balloon angioplasty or stenting alone than men did and also had higher rates of preventing amputation after balloon angioplasty.[11] Additionally, limb salvage was significantly greater for females at all time points in the PTA group.

The takeaway: Because open surgery shows more complications in women than men, and endovascular approach shows better blood flow after intervention in women than in men, an endovascular approach should be the first line of treatment for PAD in women, before more invasive treatment methods.

These conclusions lead us to the same recommendations that are pillars of PAD Awareness Month:

-Patient and physician education of PAD (and how it affects both men and women) is of the utmost importance.

-Consistent, annual screening is extremely important, especially for groups that are likely to have PAD without any symptoms.

-A minimally invasive approach first is best and safest for all patients, but perhaps especially important for women.


[1] https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death

[2] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm#:~:text=Heart%20disease%20has%20been% 20the,approximately%2040%25%20of%20all%20deaths.

[3] Schramm K, Rochon PJ. Gender Differences in Peripheral Vascular Disease. Semin Intervent Radiol. 2018 Mar;35(1):9-16. doi: 10.1055/s-0038-1636515. Epub 2018 Apr 5. PMID: 29628610; PMCID: PMC5886764.

[4] Diehm C, Schuster A, Allenberg JR, et al. High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 2004;172(01):95–105

[5] Sigvant B, Wiberg-Hedman K, Bergqvist D, et al. A population based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg 2007;45(06):1185–1191

[6] McDermott MM, Greenland P, Liu K, et al. The ankle brachial index is associated with leg function and physical activity: the Walking and Leg Circulation Study. Ann Intern Med 2002;136(12):873–883

[7] McDermott MM, Fried L, Simonsick E, Ling S, Guralnik JM. Asymptomatic peripheral arterial disease is independently associated with impaired lower extremity functioning: the women’s health and aging study. Circulation 2000;101(09):1007–1012

[8] McDermott MM, Greenland P, Liu K, et al. Sex differences in peripheral arterial disease: leg symptoms and physical functioning. J Am Geriatr Soc 2003;51(02):222–228

[9] Lancaster RT, Conrad MF, Patel VI, Cambria RP, LaMuraglia GM. Predictors of early graft failure after infrainguinal bypass surgery: a risk-adjusted analysis from the NSQIP. Eur J Vasc Endovasc Surg 2012;43(05):549–555

[10] Nguyen LL, Brahmanandam S, Bandyk DF, et al. Female gender and oral anticoagulants are associated with wound complications in lower extremity vein bypass: an analysis of 1404 operations for critical limb ischemia. J Vasc Surg 2007;46(06):1191–1197

[11] Gallagher KA, Meltzer AJ, Ravin RA, et al. Gender differences in outcomes of endovascular treatment of infrainguinal peripheral artery disease. Vasc Endovascular Surg 2011;45(08):703–711

Patient Story: Keeping Veterans on Their Feet

Patient Stories: Keeping Veterans on Their Feet

Written By Kirstin Rizk

Seventy-year-old U.S. Army Veteran and former police officer, Paul Kaminski, was still mourning the loss of his wife of nearly 50 years when he started having pain while walking. He’d have to pause at his mailbox to let his calf muscles recover before heading back inside. He had given up golf. When his daughter would invite him to his granddaughter’s swim meets or theatre performances, the first thing he would have to ask was, “How far is it from where I can park?”

Once his pain began interfering in his ability to be present for his granddaughter’s big moments, he decided that he would not be passive while pain limited his life. He visited his primary care doctor at the Veteran Affairs office, and she told him that he likely had peripheral artery disease (PAD) and recommended that he start a walking routine to strengthen his collateral blood vessels. While exercise can be an effective treatment for PAD, Paul’s PAD was past that point. He could hardly walk to the mailbox without severe pain and cramping – walking to force blood through weak collaterals was definitely out of the question.

“I couldn’t make my doctor understand, that’s how bad my pain was,” Paul explained, “it was very limiting.”

After seeing an advertisement for Modern Vascular’s endovascular specialists performing limb-saving procedures with cutting-edge technology, Paul knew this might be his chance to get his PAD treated and relieve his pain.

“Going to Modern Vascular was one of the best things I’ve ever done in my life,” Paul said.

The team at Modern Vascular in Houston confirmed the diagnosis of PAD and performed an angiogram where they discovered the arteries of both legs were almost completely blocked. They immediately took action, clearing the arteries of his legs and placing stents to keep them open.

Paul felt nothing during his procedure and felt supported the entire time he was in the clinic. “The people there, the staff, the doctor, they are all just wonderful people to talk to, very informative, very enlightening,” he said. “And, you know, I am back swinging a golf club a day or two after the revascularization.”

Paul talked about the difficulty of losing his beloved wife of nearly 50 years and then encountering this new pain while walking shortly after. He continued, “And then to have people like the people at Modern Vascular take on another part of life which was not good and to have an organization like this do what they did is just a fairytale… They basically are honoring our veterans in that manner… I mean, brings tears to an old man’s eyes.

Thanks to Modern Vascular of Houston, Paul is once more playing golf, hunting, fishing, and most importantly, attending all of his granddaughter’s events without being limited by PAD.

“It was almost like a rebirth,” Paul said. “I mean, I was so totally limited two days prior, and now I can do anything I want to do.”

To learn more about the non-invasive vascular solutions that Modern Vascular offers or to find answers to your PAD-related problems, you can call (888) 853-1278 or use the online form at ModernVascular.com to request a consultation with a Modern Vascular Patient Advocate.

PAD Awareness Month 2022 Revascularization Blog

With PAD, Awareness is Just the Start: Taking Control of Your PAD

By Kirstin Rizk

September kicks off Peripheral Artery Disease (PAD) Awareness Month so we are sparking conversations about preventing and controlling PAD. In this post, we hope to increase awareness of disease management methods for patients who already know they have PAD.

With PAD, arteries in the feet and legs are too clogged to deliver a healthy supply of blood to the tissues of the legs and feet. In mild to moderate PAD, though it can be slightly painful, the first course of treatment is usually a walking plan because it reinforces “collateral” pathways for blood to travel if it cannot make its way through the main arteries because they are too clogged. Walking increases heart rate and blood pressure for the duration of exercise which helps to reinforce these naturally made bypasses. Continuing a walking plan strengthens these collaterals and it gets less painful to walk.

However, with PAD that is further advanced, the collaterals are also too clogged to provide enough blood supply to keep muscles in the calves and feet oxygenated. Pushing through the pain during walking is too painful and likely fruitless because the main arteries and collateral arteries are all far too occluded to maintain the high oxygen demand of walking.

When this occurs, it’s very difficult for the patient because it feels like their health is taken out of their control. They can’t exercise, maintain a healthy heart rate or weight, and are often forced to give up outdoor hobbies they love. This process can be equally detrimental to mental health as it is for physical health.

Unable to make much headway on managing their PAD with diet and medication alone, Modern Vascular then recommends a revascularization procedure. It gives Modern Vascular physicians immense pride to do an outpatient procedure and have the patient home again the same day with their autonomy back. After a revascularization procedure, the arteries of the legs have been cleared, sometimes stents are placed, and blood is once again pumping adequately through the legs and feet.

After revascularization, patients can begin walking/exercising again which maintains their newly opened arteries. Between the ability to exercise again and implementing a heart-healthy diet low in fats and simple sugars, patients can take control of their own health again. Finally, patients have their autonomy back and no longer feel helpless in their own health.

A case study representing this: Geoffrey Potts loved woodworking, hunting, fishing, biking, and walking. When Geoff began experiencing PAD symptoms around 2014, the distance he could walk through the pain got shorter and shorter until he had to give up his outdoor hobbies. He didn’t feel like his health was something he had any control over. Finally, in 2021, he saw Dr. Juan Carlos Correa at Modern Vascular in Kansas City. Dr. Correa finally solved the problem keeping Geoff from doing the things he loved. After his revascularization procedure, Geoff’s pain was so significantly improved and he returned to his favorite outdoor pastimes with such fervor that he lost 60 lbs. Geoff is a perfect example of someone who, thanks to a revascularization procedure, could take his health back into his hands.

Whether a PAD patient’s disease is severe enough to have an endovascular intervention or not, it is important to remember that PAD is a lifelong disease. Patients with PAD should have follow-up appointments with their vascular specialist every year or as often as their specialist suggests.

Patient Stories: “No Longer Bedridden at 27”

Written By Kirstin Rizk

Christian Schott is a patient of Dr. Jean-Baptiste.

At 27, Christian stands apart from Modern Vascular’s usual demographic: patients typically middle age or older. Yet Christian’s symptoms were among the most severe, resulting in three or four emergency room visits over the last few years before finally receiving treatment for his excruciating foot pain.

As a custodian, Christian spends a lot of time on his feet. So, when he began to experience bouts of terrible foot pain about three years ago, his life and work were both majorly disrupted. With seemingly no cause, he would wake up, try to stand, and immediately fall to the ground from the pain. He added, “Usually, I would just wake up with it and I’m like, ‘Okay, I’m going to be bedridden, I can’t move or walk at all today.’”

His primary care doctor and the doctors at the emergency room suspected Christian’s pain was being caused by gout, a type of inflammatory arthritis, and said that the pain would go away in a few days. Perhaps because Christian doesn’t fit the typical demographic for peripheral artery disease, this potential cause of his pain was ruled about before being considered.

Finally, orthopedic surgeon Dr. Reyes referred Christian to Modern Vascular. Christian explained, “I was very blessed. Everyone was super nice and understanding and for the first time I didn’t get ‘it’s gout, we don’t know what to do,’ it was ‘let’s order a few tests, let’s try this, are you okay if we try this?’ Before they would even touch my foot or anything else they would be like, ‘Do I have permission to try to move this around?’… I felt really loved and taken care of when I was there.”

During his evaluation, Modern Vascular’s specialists checked the capillary refill in Christian’s feet. This test is easy and painless: a squeeze on the foot or toe, and count the seconds until the color returns. It should not take more than 2 seconds.[1] For Christian, it was 7 seconds.

This showed that Christian’s foot was not receiving enough blood flow, due to narrowing or blocking of the arteries in his legs. This could explain why, as Christian described, his foot could “turn any color from purple, blue, sometimes even a little green or black.” It could also explain why sometimes his pain was so bad he had to crawl to the bathroom to avoid putting pressure on his foot.

Christian was recommended for procedure at Modern Vascular. Of his experience during the procedure, he said, “they told me what they would do before they did it, like what to expect, just all the things that you want to hear when you have a procedure or go to a doctor’s office.”

A few days after his procedure, Christian’s foot already felt lighter. He has not experienced the debilitating pain that used to occur every month or month and a half since his procedure. Christian is on schedule to see a rheumatologist soon to ensure that he is not additionally having joint-related issues, but there is no doubt that his severe peripheral artery disease was complicating, if not outright causing, his debilitating pain. Thankfully, he is now on track to live the pain-free and healthy life that a 27-year-old should be.


[1] Sansone CM, Prendin F, Giordano G, Casati P, Destrebecq A, Terzoni S. Relationship between Capillary Refill Time at Triage and Abnormal Clinical Condition: A Prospective Study. Open Nurs J. 2017 Jul 26;11:84-90. doi: 10.2174/1874434601711010084. PMID: 28839512; PMCID: PMC5543682.

Patient Stories: Leonard Whitworth Modern Vascular in Southaven Dr. Leschak

Patient Stories: “I feel like a brand new man.”

By Kirstin Rizk

Leonard Whitworth, 63, had been experiencing terrible, unpredictable cramping in his legs and feet for 20 years. When asked about what brought on the pain, Leonard said, “it could be sitting in my chair watching tv, it could be driving down the road, it could be walking through a grocery store or at my job, it would just come on.”

The pain would even wake Leonard up in the middle of the night. He recounts, “I would have to get up and walk the cramp out of the bottom of my feet a couple times a night, about 3-4 times a week. It would hurt so bad it would bring tears to my eyes.”

For 20 years, Leonard attributed his leg and foot pain to getting older and working on his feet for much of his life. He described these terrible cramps recently when he visited a podiatrist. He also explained another symptom he was having: His feet were so cold that he wore battery-operated heated socks. He recalls, “I had to wear one on my right foot even if it were 90 degrees out.” Because of these symptoms and a heart attack and stroke, Leonard experienced two years before, his podiatrist knew that he was at risk for peripheral artery disease and referred him to Modern Vascular.

After evaluating Leonard, it was clear to Dr. Stephen Leschak and his team that Leonard had significant blockage of the blood flow in his legs. What made Leonard’s case even more tricky was an injury he had as a child. At 12, Leonard’s dad was doing construction on a house while Leonard helped on the roof. Young Leonard made a mistake that caused him to jump off, where he landed on a glass beer bottle. The injury was so severe that he nearly lost his foot. 51 years later, this made it more complicated to clear blockages in the arteries of that same foot.

The first time I spoke with Leonard, it was a few weeks after the procedure on his right leg. When asked about his experience getting a procedure from Dr. Leschak, Leonard says, “I feel like a brand new man… I can’t say enough about how much they’ve done for me. I’ve been in pain for a long time and now my right leg is 100%. I can’t wait to get the other one done.”

A few weeks later, I checked in with Leonard the day after his procedure on the left leg. He said, “my foot’s not cold, the cramping went away, I couldn’t ask for anything better.” In fact, he was returning to work the day after our conversation, where he works on his feet all day as a manager.

Leonard summed up his experience at Modern Vascular in Southaven saying, “Couldn’t ask for a better staff than you have right there. From the moment I went in, in the surgery, all of it.”

Finally, I asked him if he still uses his battery-operated heated socks. “No,” Leonard said, “I put them away and we’re getting rid of them. My feet stay warm.”

I also asked if his sleep has improved, and was happy to hear that now Leonard actually has to use an alarm clock, since his foot pain no longer wakes him up.

Check out Leonard’s Patient Testimonial:

https://modernvascular.com/clinics/southaven/

What Your Leg Pain Can Mean

What Your Leg Pain Could Mean

Leg pain is a common complaint of many people that could be caused by injuries or overexertion. But what happens when the pain is more severe or doesn’t go away? Here are some of the most common reasons people may experience leg pain. If your leg pain is severe or long-lasting, contact your doctor.

Peripheral Artery Disease

Peripheral artery disease is one of the more serious causes of leg pain. The arteries that bring blood to your limbs can become inflamed and stiff, which can cause leg pain when exercising or getting up from a seated position. If caught early enough, you may be able to prevent permanent damage by taking medication or going through physical therapy.

Atherosclerosis

Peripheral artery disease is a condition caused by atherosclerosis in the peripheral arteries. Atherosclerosis is when the walls of the arteries harden and the blood vessels narrow. Arteries are the blood vessels that bring oxygen and nutrients to your body, including your leg muscles. These blockages can be especially dangerous in the leg arteries because it makes it difficult for oxygenated blood to reach your feet.

Some conditions that contribute to atherosclerosis are high cholesterol, obesity, and other factors that increase your risk of high blood pressure and heart disease. If you have diabetes or a family history of this condition, you should be particularly cautious.

Peripheral artery disease can lead to tissue damage and even amputation, so if you are experiencing the symptoms, contact your doctor immediately.

Healthy lifestyle changes can decrease your risk of developing peripheral artery disease. These include eating a healthy diet, exercising regularly, and quitting smoking. Moderate activity such as walking lowers your risk by helping keep your arteries flexible. There are also some treatments available. Minimally invasive endovascular procedures are an option that has fewer risks involved and a quicker recovery time than other procedures.

Venous Insufficiency

Venous insufficiency is when the blood vessels become enlarged due to blood pooling because of issues with pumping blood back to the heart. It is common in people who have jobs that require prolonged standing and those who are pregnant. Varicose veins are venous insufficiency in the superficial veins, such as the legs, hands, or face.

Treatments for venous insufficiency include elevating legs while sleeping, compression stockings, and other lifestyle changes like exercise and weight loss. Venous insufficiency can cause discomfort or aching pain. Contact your doctor if you have pain or a significant number of varicose veins.

Studies have shown a correlation between varicose veins and heart disease. Varicose veins can be indicative of cardiovascular disease. You should consult with your doctor to determine if your leg pain is due to this condition.

Shin Splints

Shin splints can be caused by overuse or repetitive stress on the shin bone or a traumatic injury to the tibia.

Shin splints are a common diagnosis among runners, but it has many other causes. People who have had long periods of inactivity should consult their doctor to determine if they may have shin splints.

The condition is cured by resting and decreasing the intensity of your activity. You can also wear a brace or other equipment to support your legs and help relieve the stress on your shins.

Sciatica

Leg pain can also be caused by a condition known as sciatica, which is an inflammation of the sciatic nerve. It occurs when the nerve becomes irritated from pressure or irritation on one side of the body. Sciatica can be caused by back pain, an injury or infections in the area where it travels, and even a tumor or herniated disc in your spine.

Sciatica can be temporary or chronic, which means it is not curable with medication and will last for an extended period. Typically, patients will experience acute sciatica in which the pain comes and goes. Chronic sciatica can lead to permanent nerve damage. It is more common among older people and those with multiple medical conditions like diabetes or arthritis.

Leg pain is usually worse when lying down or getting up from a seated position for people suffering from sciatica. Patients with sciatica should stay as active as possible to relieve stress on the nerve and help prevent long-term nerve damage.

Osteoarthritis

Osteoarthritis is the most common form of arthritis, brought on by inflammation of the cartilage that supports your joints. The cause of osteoarthritis is typically overuse or repeated stress on your knee joint.

Osteoarthritis usually occurs in both knees on both sides but can be painful in any joint and may affect only one or two joints. Osteoarthritis can also occur in other joints, but symptoms may not be as severe. Symptoms are typically less acute than those associated with osteoarthritis in the knee.

Osteoarthritis is most common in people over 50 years old, but it can also occur among younger people that have obesity, diabetes, or who have experienced a traumatic injury.

Osteoarthritis treatment options include changing lifestyle habits, taking medications, or a total knee replacement. There is also a minimally invasive procedure called Genicular Artery Embolization that can reduce osteoarthritis knee pain. It blocks capillaries from supplying blood to the inflamed tissue that causes knee pain.

Conclusion

Now you know some sources of leg pain. Some of the causes of leg pain are more severe than others. If you have severe or prolonged leg pain, you should see a doctor. If you think that you have peripheral artery disease, osteoarthritis, or venous insufficiency, contact Modern Vascular and speak to a patient advocate about the symptoms that you are experiencing.

Meet Dr. Marc L. Eckhauser

Prominent Arizona Vascular Surgeon Joins Modern Vascular in East Mesa

Dr. Marc Ekhauser explains why after 22 years of endovascular surgery in the Phoenix area, he decided to become a Modern Vascular Managing Physician.

Interviewer:  Dr. Eckhauser, tell me a little about your background.

Dr. E:  I started my career and practiced as a Vascular Surgeon in Ohio for many years, serving on the faculty of Case Western Reserve, teaching General Vascular Surgery.  I was doing open surgeries at that time and traveling the country speaking and doing presentations for other doctors.  In 1995, I spent some time at the Arizona Heart Institute and started to see that the standard of treatment for vascular disease was changing.  I realized that endovascular procedures were the future.  I wanted to be ahead of the curve and so I made the shift and started to develop an endovascular practice in Ohio.  In 2002, I moved to the Phoenix area and spent some time with Advanced Cardiac Specialists and Arizona Vein and Vascular where I enjoyed very successful practices as an endovascular specialist.

Interviewer: So after 20 years of a successful endovascular practice in the Phoenix area, why did you choose to start a new practice with Modern Vascular?

Dr. E:  Modern Vascular started to show up on my radar around 2019, they reached out to me about a potential opportunity to lead a clinic.  I did a little research but ultimately stayed put, just in time for the pandemic.  But 2 years later I was still interested, and so this time I reached out to Dr. Scott Brannan at the Mesa clinic who invited me to join him for a procedure.  Scott and I immediately hit it off and I once again found myself seeing an opportunity to be ahead of the curve.  Modern Vascular was performing pedal loop revascularizations on almost every patient.  This was something, I wasn’t seeing in other practices, but I understood the value of the treatment.  I knew that to deal with wounds and lifestyle-limiting pain due to poor arterial blood flow, the treatment had to deal with the small vessels in the foot.  I was thrilled to have an opportunity to learn and master a new and better way of treating Peripheral Arterial Disease (PAD).

Interviewer:  Did you meet with Modern Vascular’s CEO Yury Gampel, prior to joining?

Dr. E:  Absolutely.  An interview with Yury was an important part of the process for me.  When I met him, he immediately turned the tables and told me to interview him, which I loved.   I was particularly impressed with his honest and transparent answers, as well as his unconditional support for my clinical decision-making authority, his passion for limb preservation, and his commitment to providing the highest quality equipment and technology.  I was sold.

Interviewer: And now 3 months in, what has surprised you the most?

Dr. E:  I wouldn’t say I was surprised, but I have been really pleased with the quality of staff that I work with in the clinic.  I would also say the level of clinical and technical expertise is as high as I have seen.  We are a very patient-centric office.  I personally spend time with every patient.  I put a high priority on building rapport and making sure each patient is well educated about their condition and treatment options.  I have really enjoyed my time at Modern Vascular so far.  My kids say it’s the happiest they have seen me in a long time.

Geoffrey Potts Patient Story

Patient Stories: “I Would Drive Anywhere To Have Dr. Correa Treat My PAD”

“He asked me what I wanted out of my treatment and then he surpassed it.”

Geoffrey Potts is a retired mason and a patient of Dr. Juan Carlos Correa, Vascular Surgeon and managing physician at Modern Vascular of Kansas City in Overland Park. 

Geoff said he was originally referred to Dr. Correa by his cardiologist, Dr. Tim Blackburn, a referral he said has made all the difference. But his story begins even before that. Geoff had been suffering from leg pain for many years that he assesses came as a result of undiagnosed and thus unmanaged type 2 diabetes.  He said he first heard the term Peripheral Artery Disease in 2014 while he was in his mid-50s. However, it would take several more years of pain before he would cross paths with Dr. Correa.

As Geoff explains his journey, he told us about his neuropathy and severe leg pain that not only kept him from walking for more than a few minutes but also affected his ability to stand or bend over for extended periods of time. Explained Geoff, “I could not even walk short distances without having to think through where would be my next place to stop and rest until the pain stopped.”

Geoff was a little skeptical when he first met Dr. Correa.  After all, he had experienced this pain for a long time and wasn’t sure what could be done. He wanted to keep his expectations realistic.  Five minutes later, Geoff felt at ease. Dr. Correa looked him in the eye and asked him what he wanted out of his treatment. Geoff responded that he wanted to be able to do things he loved like woodworking, hunting, fishing, biking, and walking. Dr. Correa never lost his gaze and said “Then that is what we will work toward.”

Geoff has had two procedures at Modern Vascular in the last year, one on each leg. His last procedure was completed in mid-November 2021. Geoff and his wife, Rhonda, call the results a complete transformation. Now in his mid-60s, Geoff is walking 2-3 miles and biking 20 miles on a regular basis. His improved activity has helped him lose 60 pounds, which is transforming his health and quality of life in other ways. 

Geoff says he is a success story and that he would recommend Dr. Correa to anyone, and he adds that he has. Geoff and his wife live 2 ½ hours from the Overland Park clinic but they say that they would drive anywhere to see Dr. Correa. Geoff summarized his experience by saying “We both consider him a friend. He knows my wife as well as he knows me and asks about her when she is not there. He delivered everything we discussed and more. There is so much I can do now that seemed impossible just a year ago.”

5 Symptoms You Should Refer to a PAD Specialist - PAD Answers Blog

5 Symptoms That You Should Refer Your Patient to a PAD Specialist

The technological advances in Peripheral Artery Disease treatment that save limbs and lives every day are truly a culmination of science and art where highly trained vascular specialists apply knowledge, a caring heart, and skillful hands. Unfortunately, PAD is still very much so a silent killer making Modern Vascular’s endeavors to drive awareness, education, and tailored treatment options that much more important.  Early detection is integral for intervention and amputation prevention. 

How to know when to refer?

As clinicians, the focus is on our responsibility to heal our patients, through observation, analysis, and care plans. Knowing when it is time to refer a patient to other providers who specialize in PAD treatment can be a judgment call.  Many patients have high-risk factors but there are no showing symptoms. Risk factors include diabetes, hypertension, age, and early detection is vital for treatment.   It is customary for patients with diabetes to get their feet checked every time they see their doctor, but more patients should be checked for discoloration on the foot, and also take a pulse of the foot.  By carefully examining the foot, PCPs, Podiatrists, Endocrinologists and others can more definitely know which patients would benefit from consulting with a PAD specialist.

Here are 5 Symptoms that should be referred immediately:

PAD with Neuropathic Pain

Neuropathy, otherwise known as peripheral neuropathy, is a result of damage to the peripheral nerves located outside of the brain and spinal cord.  This damage causes weakness, numbness and pain, usually in the hands and feet, also affecting other areas and body functions including digestion, urination and circulation.

Both Neuropathy and PAD affect the lower extremities, which sometimes results in mistaking one for the other. They can both be present at the time there are a few outlying symptoms that set them apart; they include1:

Cramps in the thigh, calf, ankle, buttocks, or foot

  • Difficulty climbing stairs
  • Fatigue in the legs or achiness
  • Slow or non-healing wounds on the leg, angle, or foot
  • Temperature of one leg is cooler than the other
  • Leg hair loss or poor toenail growth
  • Numbness or weakness in the legs
  • Pain that stops at rest
  • Paleness or blueness in one or both legs

Neuropathy can occur when there are vascular disorders, in other words, when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.

PAD with Claudication

Claudication is pain in the thigh, calf, or buttocks that happens when you walk may be a symptom of peripheral artery disease (PAD).2

At first, claudication pain occurs when you walk a certain distance and goes away when you rest. But as PAD gets worse, the pain can occur when you walk shorter distances. Over time, you may no longer be able to walk because the pain is so severe.

Claudication is linked to health conditions that also increase your risk for heart attack or stroke, PAD with claudication should be checked for and then treated for by a vascular specialist who can address the artery disease in other parts of the body.

PAD with Rest Pain

More serious than Claudication is a symptom of PAD known as rest pain. When the arterial blockages are so severe that muscles aren’t getting enough oxygen while at rest. Foot pain is the most common signal. At first, it’s most troublesome when the leg is elevated, particularly in bed at night.

The earliest and most common symptom is called intermittent claudication followed by Rest Pain.  Patients usually experience it as a cramp-like muscular discomfort, but PAD can also produce numbness, tingling, weakness, or fatigue.3

People with mild blockages can walk substantial distances before the symptoms set in, but patients with severe PAD may experience distress in just a few yards. Whether mild or severe it is recommended to refer to a vascular specialist to for a guided walking program or a endovascular intervention.

PAD with Gangrene

Gangrene happens when blood supply to certain tissues is stopped. This can happen due to4:

  • Infection
  • Injury (burns, infected dog bite, or combat wound)
  • Frostbite

Diabetes, PAD, or other chronic diseases that harm the circulatory system such as Raynaud disease, can lead to gangrene if they are severe and not under control.

If the patient’s gangrene is caused by poor blood flow, it may time to recommend your patient for vascular surgery to improve circulation. For instance, when gangrene is a result of a blocked artery, the patient may have bypass surgery or an angioplasty to address the condition.

Wounds that Won’t Heal

Chronic or nonhealing wounds and ulcers are caused by blockages in the arteries (arterial ulcers) and the result of a loss of sensation, often seen in patients with diabetes (neuropathic foot ulcers). Patients with underlying PAD and chronic wounds are at a higher rate of amputation. Referring to a PAD Specialist will help prevent serious complications in the early stages, helping to identify and treat both the PAD as well as other factors which may be impacting wound healing. Patients with underlying PAD are at increased risk of developing non-healing wounds and ulcers and have a higher rate of amputation. Therefore, it is important for people that have PAD to seek out wound care. Here are some common wounds that occur in patients with Peripheral Artery Disease.

Modern Vascular is not only diligent in early detection and treatment of PAD, but focused on amputation prevention. Consider referring your patients to us for minimally invasive vascular solutions.

We return your patients ready to heal.

To learn more about Modern Vascular to answer your PAD-related problems, or to find a clinic near you to refer to a refer a patient you can call (888) 853-1278 or use the online form at modernvascular.com/referring-doctors to request a consultation with a Patient Advocate.

Sources:

Is it peripheral neuropathy or pad? Is it Peripheral Neuropathy or PAD?: Vein and Vascular Solutions NYC: Board Certified Vascular and Interventional Radiologists. (n.d.). Retrieved April 19, 2022, from https://www.vascularsolutionsnyc.com/blog/is-it-peripheral-neuropathy-or-pad

Mayo Foundation for Medical Education and Research. (2022, March 2). Claudication. Mayo Clinic. Retrieved March 24, 2022, from https://www.mayoclinic.org/diseases-conditions/claudication/symptoms-causes/syc-20370952

Rest pain. Coastal Vascular Center. (2022, January 31). Retrieved March 24, 2022, from https://coastalvascular.net/peripheral-arterial-disease-pad/rest-pain/

Gangrene is a symptom of pad – stand against amputation. Take a Stand Against Amputation. (2021, December 30). Retrieved April 19, 2022, from https://standagainstamputation.com/symptoms-of-pad/gangrene/

Pad awareness month: Take off your socks at your next doctor’s appointment! PAD Awareness Month: Take Off Your Socks at Your Next Doctor’s Appointment! | Iredell Health System – Statesville, NC. (2021, September 27). Retrieved March 24, 2022, from https://www.iredellhealth.org/news/releases/pad-awareness-month-take-off-your-socks-at-your-next-doctor-s-appointment/

Treatment strategies for patients with peripheral artery disease (PAD). Treatment Strategies for Patients With Peripheral Artery Disease (PAD) | Effective Health Care (EHC) Program. (n.d.). Retrieved April 15, 2022, from https://effectivehealthcare.ahrq.gov/products/peripheral-artery-disease-treatment/research-protocol

John Scallions Modern Vascular APP

The Importance of APPs in Amputation Prevention

A Conversation with John Scallions, NP, Modern Vascular in Southaven

Modern Vascular’s mission is focused on Amputation Prevention year-round, we work towards the eradication of lower leg and foot amputation in the general public and specifically among under-resourced and underserved communities. In observance of Limb Loss and Amputation Awareness Month, this April we’re celebrating the Advanced Practice Providers (APPs), otherwise known as Nurse Practitioners and Physician Assistants, who are integral to saving the limbs and lives of patients every day.

John Scallions, MSN, FNP-BC, Nurse Practitioner at one of our busiest clinics in the Mississippi Delta Area, Modern Vascular in Southaven, discusses his role in amputation prevention.

What is the role of the APP at Modern Vascular?

John: “We touch every soul that walks through the doors of Modern Vascular. We perform the initial assessments, gathering medical history on these patients and performing our examinations on the patients in order to see if they have any significant PAD that could lead to amputations in the future.

Many of our patients actually come into the clinic and aren’t aware that the symptoms they’re having are actual PAD symptoms. I find that patients feel it is their norm to be having the pains they’re having in their lower extremities.

How are you involved in patient education?

John: “When we start teaching them about the symptoms of PAD and critical limb ischemia. This light bulb goes off in their head and they’re like, gosh, I’ve been having this for so long, and it’s been ignored. They’ve been told that it’s just normal aging or that it is arthritis. And then when we actually get in and investigate, we find issues that need to be taken care of immediately and can intervene and hopefully set these people on a path that veers them away from amputation.

We work closely with the patient’s primary care providers, we give suggestions and examinations on medication needs, exercise needs, and diet changes. So the APP role is multifaceted. We have to help guide them in the right direction from dietary, smoking cessation, or taking their medications as prescribed.”

Why is amputation prevention important to you?

John: “Amputation prevention is the number one goal I have. Once you start to see the first amputation, it seems that will snowball into future amputations. And these patients usually do not do well. I want them to keep both legs and their toes. As we know, one amputation usually leads to several and this increases their morbidity. It would be a disservice for me not to do everything that I could and perform every diagnostic tool assessment that I can. Our APPS all have the integrity and the compassion to truly be advocates for our patients.”

Modern Vascular in Southaven is top-rated for their consults and general patient experiences in the company in part due to how thorough John is with his patient education and advocacy.

To learn more about the non-invasive vascular solutions that Modern Vascular offers or to find answers to your PAD-related problems, you can call (888) 853-1278 or use the online form at ModernVascular.com to request a consultation with a Modern Vascular Patient Advocate.

Mike Ludwig Patient Story

Patient Stories: “Modern Vascular Gave Me the Answers I Needed”

It wasn’t Peripheral Artery Disease (PAD), but it was something.

Mike Ludwig is a retired business owner and long-time resident of San Antonio. 

In January of this year, Mike saw a Modern Vascular ad on Facebook that spoke to him. The ad explained that night-time leg cramps could be a sign of Peripheral Artery Disease (PAD) and he wanted to learn more. He called the number on the Modern Vascular website and spoke to Licensed Vocational Nurse and Patient Advocate, Julie Miller. Mike told Julie about his leg pain, describing his legs as feeling like “a chunk of concrete”, “in a vice”, “electrically charged” and “on fire.” Julie explained to Mike that much of what he was feeling were classic symptoms of PAD but he should have a complete consultation to know for sure. 

Mike was in a great deal of pain and instead went to the ER that night, where he said they provided a quick exam and an initial diagnosis of sciatica.  But something about this just did not sit well with Mike and he soon gave Julie another call and asked if he could please see a medical professional at Modern Vascular’s Lexington location. 

Upon entering the clinic Mike was immediately thrilled with the attention he received, starting with Christine at the front desk. “Everyone was so professional,” said Mike.  “They kept telling me, we are going to get to the bottom of this. I really felt like they cared about my well-being.”  Mike said the ultrasound tech, Michael Johnson, was extremely thorough, reviewing his entire vascular system from head to toe. 

The Advanced Practice Provider, Karen Summy, took the time to explain all of the findings in detail and answered his questions. The news was not good. They found a 100% blocked aorta and an 80% blocked carotid artery. Mike would need major surgery, and they referred him to a Vascular Surgeon at a local hospital who specialized in his condition. 

Even though Mike was not a candidate for Modern Vascular’s services, Mike is appreciative to everyone on the Modern Vascular team for their help.  “Julie was a Godsend.” He said.  “She got me on the right path and then the clinic team took it from there. At the hospital, they did not even take my sock off. So many people are eager to tell a bad story when things don’t go their way.  I wanted to take the time to talk about Modern Vascular’s gold standard care. I am just so thankful.”

can you reverse pad

Can You Reverse Peripheral Artery Disease Naturally?

How to Slow the Progression of PAD Symptoms

Living with Peripheral Artery Disease (PAD) can be challenging, as this condition develops when plaque, made up of fats and other substances in your bloodstream build up in your arteries, making it harder for your arms, legs, head, and organs to get enough blood.1 If blood can’t get to these areas, tissue damage and eventually tissue death can occur. Left untreated, there is a chance of stroke, heart attack, kidney disease, amputation, and can be life-threatening.

Many people ask our doctors how they can reverse PAD naturally. There isn’t a cure, but you can manage, and possibly even reverse, the symptoms. It is preferred to manage PAD with lifestyle modifications, but there are also minimally-invasive endovascular procedures available if it cannot be managed by those changes.

What Lifestyle Changes Can You Make to Treat PAD?

There is no cure for PAD, but you can manage your PAD symptoms and stop the progression of the disease through the following lifestyle changes:

how to reverse pad naturally

Exercise

A key component to PAD symptom reversal is exercise. Studies show that patients who engage in regular physical activity may lead to fewer and less severe symptoms.1 The distance a patient can walk without pain is often the indicator of a successful PAD treatment.  Routine workouts can also aid in improving your mood, self-esteem, energy, and sleep. Exercise can also reduce your risk of other cardiovascular diseases such as heart disease, stroke, or heart attack.

Don’t know where to start? Well, walking is an excellent option. Your doctor might recommend supervised exercise therapy or a walking program to help manage your PAD. Regardless of the exercise regimen chosen, consistency is the key. The goal is to get some kind of activity as often as you can.

Note: Before making any lifestyle changes to help with your symptoms it is important to discuss with your Primary Care Physician (PCP) or Vascular Specialist.

smoking cessation

Quit Smoking

Tobacco use and smoking constricts and damage your arteries and is a significant risk factor for PAD. Smoking cessation reduces the risk of your symptoms developing further and lowers your odds of Cardiovascular Disease (CVD).

Studies show that people who keep smoking after their diagnosis have a higher risk of death from complications of heart disease than those who quit after their diagnosis.2

If you’re having trouble quitting on your own, ask your doctor about smoking cessation programs that might include the following, behavior modification programs, nicotine replacement therapy, and stop-smoking support group.

Maintain a healthy weight

Healthy Diet & Weight

In living with PAD, a heart-healthy diet can help you control your blood pressure, cholesterol levels, and diabetes, which may lower your risk Many people with PAD also have underlying health issues that benefit from healthy ways of eating. In general, it is important to eat a diet low in sugar and avoid processed food, focusing on meals that highlight vegetables, fruits, and whole grains. Include low-fat dairy products, fish, poultry, legumes, nuts, seeds, and non-tropical vegetable oils like olive oil. Reduce salt, added sugars, and red meat. It is also important to maintain a healthy weight.

Avoid Certain Over-the-Counter Medications

Some over-the-counter cold medicines that contain pseudoephedrine including Advil Cold & Sinus, Aleve-D Sinus & Cold, and others, constrict your blood vessels and could make symptoms worse.1

Stop or Reduce Alcohol Intake

Long-term, heavy drinking can lead to alcoholic cardiomyopathy3, a condition where consuming too much alcohol damages your heart. Ultimately, it can cause your heart to enlarge irreversibly. This weakens the heart muscle, keeping it from pumping as well as it should, which may increase your risk of worsening your PAD symptoms. Limiting alcohol intake may be able to keep it from getting worse.

Foot care

Take Care of Your Feet

Careful foot care is especially important for people with PAD as they may also have diabetes, wounds, and/or injuries on the lower legs and feet that don’t heal. If wounds are not healing properly, it is due to poor blood flow, which puts you at a higher risk for infection. Taking care of your feet in the following manner will also improve your

Quick tips for Foot Care:

  • Wash feet daily and dry thoroughly.
  • Moisturize feet often.
  • Wear thick, dry socks.
  • Make sure shoes fit properly.
  • Treat any fungal infections immediately.
  • Be careful while cutting nails.
  • Look over your feet every day to see if you have any injuries.
  • Have a foot doctor treat bunions, corns, or calluses.
  • If you have a foot injury, see your doctor right away.

Final Thoughts

When you have PAD, your doctor will want to control your symptoms and stop further buildup of plaque in your arteries. Sometimes, lifestyle changes are enough to meet these goals. If not, your doctor might suggest medication or a procedure.

To learn more about the non-invasive vascular solutions that Modern Vascular offers or to find answers to your PAD-related problems, you can call (888) 853-1278 or use the online form at ModernVascular.com to request a consultation with a Modern Vascular Patient Advocate.

Sources:

  1. Benisek, A. (n.d.). Can I reverse peripheral artery disease (pad)? WebMD. Retrieved March 8, 2022, from https://www.webmd.com/heart-disease/reverse-peripheral-artery-disease.
  2. Mayo Foundation for Medical Education and Research. (2021, January 14). Peripheral artery disease (PAD). Mayo Clinic. Retrieved March 16, 2022, from https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/diagnosis-treatment/drc-20350563.
  3. Alcoholic cardiomyopathy: Causes, symptoms and treatment. Cleveland Clinic. (n.d.). Retrieved March 16, 2022, from https://my.clevelandclinic.org/health/diseases/21994-alcoholic-cardiomyopathy.
  4. WebMD. (n.d.). Tips for living with peripheral artery disease of the legs (PAD). WebMD. Retrieved March 16, 2022, from https://www.webmd.com/heart-disease/tips-living-with-peripheral-artery-disease.

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