PAD: One Woman's Road to Recovery

It's time to celebrate! When Barbara van Schaik, 76, was told she had Peripheral Arterial Disease (PAD) about a year and half ago, the diagnosis came as a relief. Barbara, an avid walker and hiker, developed a pain in her right leg that got progressively worse with walking. The pain took her from walking almost four miles a day to not even being able to get to the grocery store. Her first visit to the doctor was disheartening.

Thankfully, Claire Brockbank, Barbara's daughter, had been working with VDF in developing the PAD Coalition and its educational materials about PAD, and so she had learned about the disease.

"The doctor was dismissive and told my mom that she was just getting older and that she just had to learn to live with the pain," said Claire. "It really took her down when the doc told her that."

What Is PAD?
Peripheral Arterial Disease (PAD) is a common disorder that occurs in the circulatory system. Sometimes it is referred to as peripheral vascular disease, claudication, hardening of the arteries, or just poor circulation.

For those with PAD, the arteries to the legs slowly become narrowed and then blocked as a consequence of age, smoking, high cholesterol, hypertension, or diabetes. As a result, blood flow to the muscles of the legs decreases, causing them to hurt and cramp during exercise. Having PAD greatly increases the risk for heart attack and stroke.

Some patients, like Barbara, have symptoms of claudication – a cramping of the leg muscles during walking, followed by relief when resting. Other symptoms may occur in those with more severe PAD: The skin may be cool, or become either reddish or blue, there may be a loss of hair, or skin ulcers and foot sores may develop that do not quickly heal. Patients may also experience pain at rest if they have severe PAD.

It was this knowledge of PAD that prompted Claire to encourage her mother to seek out another doctor and ask to be tested for PAD. Barbara did find a cardiovascular specialist in Montrose, Colorado, where she lives. The doctor performed a simple, painless, non-invasive test called an ankle-brachial index (ABI). The test discovered a blockage in her upper right leg and Barbara was diagnosed with PAD.

If you are age 50 or less and have diabetes and one other risk factor (such as smoking, high blood pressure, high cholesterol, obesity, or diabetes), are 50-69 and have diabetes and smoke, or are over age 70, it is important to be tested. Usually, PAD can be diagnosed in your physician's office through a simple test with blood pressure measurements taken at the arms and ankles.

The treatment for Barbara's PAD was a minimally invasive angioplasty, a procedure for the surgical repair of an artery, and a 30- day regimen of an antiplatelet medication (Plavix®). An angioplasty is a balloon-tipped catheter that is passed through a blood vessel to the area that is blocked by atherosclerotic plaque. The balloon is inflated to compress the plaque against the wall of the artery, reopening the channel for the artery. The balloon is deflated and removed, and the artery repairs itself with the new, larger channel.

Treatments
Treatment methods vary but can also be simple. Usually a program of exercise and use of specific medications such as cilostazol or Pletal® may be all that is needed. More severe PAD may require angioplasty or surgery. Although there is no "cure" for PAD, there are many ways you can prevent the progression of the disease. Good health practices, diet, exercise, and not smoking will slow the progression of PAD. Some medications can reduce its symptoms, and endovascular intervention can lessen the effect of the most severe consequences of PAD.

In Barbara's case, the endovascular procedure was very successful and she was up and walking around within one week. She is now back to walking four to five miles a day in preparation for a hiking trip she plans to take in the fall in northern California. Her doctor gave her the green light to go on the hiking trip just five weeks after her procedure.

"I was relieved once I knew what was wrong," said Barbara. "Once the doctors knew what to do it was resolved very quickly and now I'm looking forward to my hiking trip this fall."

While not all cases of PAD are so easily resolved, early detection and prevention are the keys. The risk factors that contribute to PAD are smoking, high blood pressure, high cholesterol, diabetes, age (persons over 50 with one or more risk factors are more susceptible), and a history of heart disease or high levels of homocysteine (an amino acid found in the blood).

These factors do not always have to be present, as in Barbara's case; she was at a very low risk for PAD but still had a blockage. Even if you have no risk factors, it is good to visit the doctor if you have any of the symptoms and ask for the ABI test.

"I have five children and have been married for 52 years," said Barbara. "I feel that my hiking trip to California is my reward for all the hard work I put into my recovery."