Peripheral Arterial Disease: An under-recognized, slow-burning emergency

Peripheral Arterial Disease: An under-recognized, slow-burning emergency

One in twenty American adults has peripheral arterial disease, or PAD, a narrowing of the blood vessels caused by cholesterol plaque buildup. Several different risk factors contribute to the development of PAD:

  • advanced age
  • smoking
  • diabetes
  • high blood pressure
  • high cholesterol.

A family history of PAD also increases one’s risk. Those with PAD may experience pain in the calf muscle or buttock with walking, especially brisk walking or walking uphill. Some patients may develop skin discoloration of the toes or feet and even develop ulcerations and wounds that are slow to heal.

PAD is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.

Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease.Click To Tweet

Patients with PAD have a seven-times increased risk of stroke and heart attack and may suffer limb loss due to serious a skin infection called gangrene. Yet many with PAD have no knowledge of having the disease and go undiagnosed as symptoms may be attributed to other causes such as joint pain or back disease.

Alarmingly, many with the disease have no symptoms at all. Studies have shown that the disease may be overlooked even if a patient is followed by a cardiovascular specialist.

 

Illustration_Peripheral_Arterial_Disease

 

Diagnosing PAD

 

Diagnosing PAD involves a noninvasive test called an ankle-brachial index or ABI in which a reading is taken of the arms and the legs using a standard blood pressure cuff and the ratio of these readings is used to assess blood flow to the lower extremities (legs and feet). A provider may also recommend more advanced imaging such as Magnetic Resonance (MR) or Computed Tomography (CT) scans.

Once diagnosed, patients are treated according to the severity of their symptoms and care is also focused on the prevention of future events. Patients may be started on medications in conjunction with a walking program to improve their symptoms. If medicine and lifestyle intervention are unsuccessful or if a patient’s lower extremity is in jeopardy, a procedure to improve the circulation may be indicated.

Peripheral Arterial Disease (PAD) is a slow-burning emergency and an indication of vascular disease throughout the rest of the body.Click To Tweet

 

Treatments for PAD

 

There are several minimally invasive procedures that can improve the blood flow to the lower extremities. These so-called “endovascular” procedures are done under fluoroscopic (a type of X-ray) guidance and utilize small medical tubes called catheters to deliver therapy. A small balloon may be threaded into the blockage and used to dilate the vessel, called angioplasty. New technology allows these balloons to deliver medication to the blockage to prevent vessel re-narrowing after the procedure.

In a similar way, small metal-alloy tubes called stents can also be used to expand the blockage from within and also may have medication coating to keep the vessel open. These minimally invasive procedures often allow the patient to be treated and sent home on the same day. If a patient is not a candidate for an endovascular approach, a more traditional open surgery called surgical bypass may be required.

 

Living with PAD

 

  • All patients with PAD should have their medications adjusted to prevent heart attack and stroke—the major health threats to those with this disease.
  • Taking daily aspirin and cholesterol-lowering medications can dramatically reduce the incidence of serious health events.
  • Blood pressure and blood sugar levels for diabetic patients need to be strictly controlled.
  • Patients with PAD should exercise caution with skin and nail care. The skin of the feet should be kept clean and moisturized to prevent cracking and infection. Frequently, podiatrists are consulted for routine care so as to prevent inadvertent injury during nail trimming.
  • Finally, it is absolutely critical that PAD patients quit smoking.

Accurate diagnosis of PAD is important as it allows for comprehensive changes to both lifestyle and medications which can save lives. New technologies are available which help to restore circulation in those affected. Early recognition of PAD is essential to halting this insidious and sometimes silent disease.

Do you have risk factors or symptoms of PAD?

The Cardiology Center can help. Schedule an appointment with one of our highly skilled providers today.

Why does my back hurt? A spine surgeon’s analysis

Why does my back hurt? A spine surgeon’s analysis

Dr. James Califf is an orthopaedic surgeon at AppOrtho, a member of Appalachian Regional Healthcare System. Over his more than 25 years in practice, he has further refined his treatment of spinal disorders, offering non-surgical as well as minimally invasive surgical techniques. His clinical focus includes spine, shoulder, hip, hand, joint replacement and arthroscopic surgery. Learn more about Dr. Califf >

Back pain will affect 80 percent of humans at some point in their lives. It is the most common cause of job-related disability and a leading contributor to missed work days.¹ Sometimes leg pain and weakness can originate in the back. Fortunately, the majority of back pain will resolve itself in 6 to 8 weeks, but it’s important to determine if the pain is coming from a severe underlying condition. An orthopedist can evaluate the cause and recommend the best treatment for your particular condition. Your treatment plan should also include preventing a recurrence of your injury. Surgery is recommended only if other measures fail or the issue is severe enough. If you are suffering from back pain, please contact AppOrtho online or call (828) 386-2663.

Muscle/soft tissue injury or strain

One of the most common causes of pain, this injury is commonly associated with poor physical conditioning. Muscle strain can affect people of any age or activity level.

Symptoms: The pain is usually a grabbing, localized pain that can radiate to the knees and down the back of the legs

Treatment options: Exercises, minimal medication, or physical therapy.

Degenerative arthritis

Also called Osteoarthritis (OA), or “wear and tear” arthritis, this condition can be part of the aging process which begins around age 30. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change.²

Symptoms: Degenerative arthritis usually causes back pain that does not radiate down the legs past the knees unless the spurs from arthritis compress the spinal cord or a nerve. The pain is usually worse with activity and when getting up from a sitting position.

Treatment: Exercises, physical therapy, medication, activity modification and injections, or fusion surgery (rare).

2. Osteoarthritis (OA). (2017, September 6). Centers for Disease Control. Retrieved from https://www.cdc.gov/arthritis/basics/osteoarthritis.htm

 

Spine Fracture

Injury or osteoporosis can cause spine fracture.

Symptoms: Pain can be moderate or severe. If the fracture is displaced it can compress the spinal cord or nerves and cause radiating pain or nerve damage.

Treatment: Bracing, physical therapy, medication, possible kyphoplasty for osteoporotic fracture

Bulging or herniated disc

The lower back, where most back pain occurs, includes the five vertebrae (bones) in the lumbar region and supports much of the upper body’s weight. The spaces between the vertebrae are maintained by round, rubbery pads called discs that act like shock absorbers in the spine to cushion the bones as the body moves. Most people have a bulging disc, and usually they do not cause a problem.

Symptoms: When the disc compresses the spinal cord or nerve, radiating leg pain and or weakness can occur. Most disk herniation symptoms resolve without surgery. To diagnose herniated discs, an orthopedist uses an MRI or CT scan. Progressive weakness and bowel or bladder problems can be signs of a dangerous condition.

Treatment options: Exercises, medication (steroids, NSAIDs), epidural injections, physical therapy, or surgery.

Spinal stenosis

Arthritis and disc problems sometimes cause narrowing of the spinal cord. This can occur if the bone spurs are large enough to compress the nerves or spinal cord.

Symptoms: Numbness and weakness in the legs, usually with activity, that improves with sitting or bending forward.

Treatment: Exercises, physical therapy, medication, activity modification, injections, or surgical decompression

Sacroiliac Joint Damage

Pain in these joints on each side of your pelvis can be caused by arthritis, wear and tear or injury.

Symptoms: Produces pinpoint pain in the low back that occurs with sitting and activity. It can be severe.

Treatment: medication, physical therapy, injections, or possible minimally invasive fusion surgery

Treatment options

 

Anti-Inflammatory Medication– Taking a medication such as Naproxen that reduces inflammation just like you would take a vitamin – twice a day with food and water – is a great way to help the body calm down and allow itself to heal, though this may cause stomach issues as a side effect.

Physical Therapy – Physical therapy is a crucial part in recovery of a tendon tear or rupture. In order to regain motion and strength in the shoulder, one must perform exercises specifically tailored for their injury. Regaining strength takes time, and positive results should start after 4-6 weeks of physical therapy.

Injections – A steroid injection done in-office can help reduce inflammation and calm down the injured joint. Usually, these injections can only be performed every 3-4 months in order to avoid any further damage to the joint. Relief can last anywhere from weeks to months.

Arthroscopy – If you have a large or a small injury and it is not getting better with treatment, minimally invasive arthroscopic surgery might be an option for treatment and repair.

Surgery – Chronic issues such as arthritis might result in the need for surgery. X-Rays, CT scans or MRI should always be performed before moving to surgery.

Do you have joint and muscle pain?

AppOrtho can help. Schedule an appointment with one of our highly skilled providers today.

Why does my shoulder hurt? An orthopedic surgeon weighs in

Why does my shoulder hurt? An orthopedic surgeon weighs in

Dr. Benjamin Parker is an orthopedic surgeon at AppOrtho and orthopedic medical director for App State Athletics. AppOrtho is the official sports medicine provider for App State Athletics, Watauga High School, and the High Country Soccer Association. Learn more about Dr. Parker >

Many people experience shoulder discomfort or pain at some point in their lives. Why does your shoulder hurt? The shoulder is a complex joint, made up of multiple muscles, tendons, and bones that work together to allow us to perform everyday activities – from playing basketball, to working in the garden.  When just one of these components is disrupted by overuse or injury, the shoulder can become painful. Pain in the shoulder can present itself in many different ways, which can be overwhelming and confusing. Do you need shoulder surgery? Maybe, but there are some non-surgical options to consider first. This article’s purpose is to provide information and possible treatment options for common causes of shoulder pain. If you are suffering from shoulder pain, please contact AppOrtho online or call (828) 386-2663.

Arthritis

As we age, our bodies go through some wear and tear, which can result in an arthritic shoulder. This is a normal process that middle-aged to elderly individuals begin to experience.

Symptoms: Shooting and catching pain that originates in the shoulder and stops at the elbow is a common sign of an arthritic shoulder. Overuse of an arthritic shoulder can cause inflammation to enter the shoulder resulting in stiffness and worsening pain.

Treatment Options: anti-inflammatory medication, injection, possible arthroscopy or replacement

Subacromial Bursitis

Bursa are fluid filled sacs that reside inside joints all over the body, including the shoulder below a bone called the acromion. These sacs help reduce friction between muscles sliding over bones and can sometimes become inflamed and irritated due to day-to-day use.

Symptoms: The arm may feel weak or painful, especially when it is lifted to the side.

Treatment Options: anti-inflammatory medication, physical therapy, injection, possible arthroscopy or cleanup

Rotator Cuff Tendons/Muscles

The rotator cuff is made of four main muscles and associated tendons. These muscles and tendons can tear or avulse (pop off the bone) during physical activity or a traumatic event such as a fall. Chronic wear and overuse can also cause a tear.

Symptoms: Stiffness, pain and weakness of the shoulder are common symptoms as well as feeling a ripping or popping sound during the time of the injury.

Treatment Options: anti-inflammatory medication, physical therapy injection, possible arthroscopy and repair

Biceps Tenosynovitis

The biceps tendon lies within a groove in the front of your shoulder and sweeps in a “windshield wiper” motion across this groove during day-to-day activities. This repetitive motion can irritate the tendon and cause inflammation in the shoulder.

Symptoms: A biceps tendon problem can be associated with pain in the front part of the shoulder. If rubbing or massaging the front shoulder is sensitive or painful, this might be an indication of biceps tenosynovitis.

Treatment Options: anti-inflammatory medication, physical therapy, injection, possible tendon reattachment arthroscopically

Treatment options

 

Anti-Inflammatory Medication– Taking a medication such as Naproxen that reduces inflammation just like you would take a vitamin – twice a day with food and water – is a great way to help the body calm down and allow itself to heal, though this may cause stomach issues as a side effect.

Physical Therapy – Physical therapy is a crucial part in recovery of a tendon tear or rupture. In order to regain motion and strength in the shoulder, one must perform exercises specifically tailored for their injury. Regaining strength takes time, and positive results should start after 4-6 weeks of physical therapy.

Injections – A steroid injection done in-office can help reduce inflammation and calm down the injured joint. Usually, these injections can only be performed every 3-4 months in order to avoid any further damage to the joint. Relief can last anywhere from weeks to months.

Arthroscopy – If you have a large or a small injury and it is not getting better with treatment, minimally invasive arthroscopic surgery might be an option for treatment and repair.

Replacement – Chronic issues such as arthritis might result in the need for replacement. X-Rays, CT scans or MRI should always be performed before moving to surgery.

Do you have joint and muscle pain?

AppOrtho can help. Schedule an appointment with one of our highly skilled providers today.

3 ways to warm up the Winter Blues

3 ways to warm up the Winter Blues

Endless grey skies, drizzle to snow mixtures, and wind so gusty you see it coming before it hits you paints a not-so-colorful stretch of winter weather typically found in the High Country. Days of dark, dreary weather have been known to make some folks come down with the winter blues or its more extreme version, Seasonal Affective Disorder (SAD).

Winter Blues - Seasonal Affective Disorder“The winter blues are fairly common in our area with long winter months and very grey days. The challenge is diagnosing whether a client has a mild case of winter blues, Seasonal Affective Disorder, or another form of depression,” says Lisa Shelton, a Licensed Clinical Social Worker and Director of the Employee Assistance program with Appalachian Regional Healthcare System.

Symptoms for the winter blues and Seasonal Affective Disorder (SAD) appear to be similar on the onset and may include:

  • Sleep issues (either too much or not enough)
  • Fatigued to the point where it is difficult to carry out daily routines
  • Overeating and/or strong cravings for “comfort foods,” especially carbohydrates
  • Lack of interest in normal activities
  • Social withdrawal

Treatment techniques will determine whether or not the winter blues really are SAD or another form of depression. Shelton recommends a three-step process to clients describing some form of the winter blues.

 

Step one: Exercise

Wellness CenterYes, it’s a verb buzzed about all the time, but all this talk must lead to positive results because doctors, counselors, and other healthcare professionals are always recommending it. And, our area offers the Paul H. Broyhill Wellness Center, the Greenway, several parks, and sidewalks round about Boone to help you enjoy slivers of daylight during the winter months. A long walk outside helps refresh your senses, and if it is too yucky to go out, a creative solution may be to brighten up your home and do some jumping jacks, run-in-place, or stretches. Any form of exercise will help you warm up the winter blues.

 

Step two: Strive to sleep and rest well

Sleep StudyIf you exercise, you’re more likely to tire yourself out and sleep better. Other considerations include reducing caffeine intake, make an effort to turn off your thoughts (counting sheep is always a popular game), or just simply lying there and resting. If you continue to have trouble sleeping, seek your doctor’s advice and ask if a sleep study is right for you. If you are sleeping too much, make an effort to avoid snoozing past eight hours.

 

Step three: Engage in an activity that gives you pleasure

Art-Therapy-2This suggestion seems simple enough, but people often struggle with time and money to make it happen. However, if you make it a priority, you’re likely to come up with an affordable solution that fits your budget. Popular winter activities may include reading, completing craft projects, sledding, ice skating, or other ideas discovered by talking with friends.

 

 

Be self-aware

“Being aware of your symptoms is so important to getting past the winter blues. We’re most vulnerable when we’re unaware of what’s going on with us. Sometimes sitting down and talking with a trusted friend, family member, or professional, qualified healthcare worker can be very successful in dealing with the winter months,” continues Shelton.

If the above three steps do not seem to help your mood, seek the advice of your doctor or a licensed behavioral healthcare worker. Appalachian Regional Behavioral Health Services offers crisis care, therapy, and psychiatric services if you should need professional help.

 

Treatment

Treatments for Seasonal Affective Disorder (SAD) may include light therapy, which involves exposure to daylight or a specially-made fluorescent bright light for 30 minutes to two hours a day. SAD can often be confused with other forms of depression, and patients with SAD aren’t usually diagnosed with it until their symptoms can be observed over a period of one or more fall/winter seasons.

Shelton concludes, “The most important consideration is to take the time to make your mental health a priority. People affected by the winter blues or other more serious forms of depression must strive to adjust their routines in order to have success, and the rewards of a happy, healthy mind are well worth the effort.”

Contact Appalachian Regional Behavioral Health at (828) 737-7888 or visit the website


 

For High Country employers: 

Lisa Shelton and staff of the Employee Assistance Program (EAP) are available to provide short-term professional help and guidance to all employees and their family members of the Appalachian Regional Healthcare System as a part of the system’s benefits program. The EAP is highly confidential and accepts voluntary self-referrals. Additionally, the EAP contracts to provide services for the Town of Boone, Town of Beech Mountain, Grandfather Mountain, Boone Drug, several doctors’ offices, and other organizations throughout the High Country. For more information about EAP, call (828) 263-0121.

A version of this article, written by Koren Huskins first appeared in Carolina Mountain Life Magazine, and is republished with permission.