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ISSUE 0004



“Mrs. Collins is choosing her wall color scheme...are her varicose veins lavender or more purple?”

Which Twilight Star Suffers from Restless Leg Syndrome? (Look inside to find out!)

IN THIS ISSUE Early Diagnosis is Let’s Talk About E-Cigarettes Restless Leg

1836 Florida Avenue, Panama City, FL 32405 Phone: 850-872-8510 • Fax: 850-872-7412

Twilight Star suffers from (RLS) Restless Leg Syndrome, a symptom of PAD.

When it Comes to PAD Early Diagnosis is the Key

Article PA-C Art c e by: y Clark Stream, t P If you are among the 24 million Americans with diabetes, you are approximately four times more likely to develop PAD than a person without diabetes.

Taylor Lautner suffers from restless leg syndrome, Star Magazine has reported. The syndrome makes it hard for him to just sit without bouncing his legs. “I can never stop bouncing my knee,” says the actor who claims his fame for his starring role as Jacob Black in “Twilight”. “People always tell me to stop, but I can’t force it to stay still. If we’re in the car, I’ll end up shaking the whole car.” There hasn’t been record since when Taylor is battling the particular syndrome. It is also not mentioned how far the syndrome affects his daily activities. Referring Source


PAD, (Peripheral arterial disease) happens when there is a narrowing of the blood vessels outside of your heart. The cause of PAD is atherosclerosis. This happens when plaque, a substance made up of fat and cholesterol, builds up on the walls of the arteries that supply blood to the arms and legs. The plaque causes the arteries to narrow or become blocked. While the primary early symptom of PAD is intermittent claudication, or leg pain while walking, the presence of diabetes reduces the likelihood of any symptoms at all. To help prevent disability, amputation, a heart attack or stroke, early diagnosis and treatment of PAD are vital. According to current treatment guidelines, diabetics over age 50 should undergo an ankle-brachial index (ABI), a test in which blood pressure in the ankle is measured and compared to that in the arm. If the ankle pressure is lower than the arm pressure, a PAD diagnosis is likely. Patients with diabetes can greatly improve their chances of remaining PAD-free with preventive measures against cardiovascular disease, that is, controlling blood pressure (below 120/80), cholesterol (LDL below 100 mg/dl) and blood sugar (AIc below 7 percent) as well as quitting smoking.

PAD meets modern Technology Recent advances in technology have proved of great benefit to patients with diabetes and PAD. In the past five years newer surgical techniques, called endovascular interventions


have been used to treat patients with PAD. By using devices like balloons, stents and atherectomy catheters to treat the plaque in the arteries, many patients are kept from having open surgical bypass procedures. Artherectomy is a procedure in which plaque is removed from the arteries using a laser or rotational device. With aggressive medical management, we are making the right steps toward preserving life and limb. September is PAD awareness month. National medical guidelines recommend that certain individuals be tested for PAD. Take this simple PAD quiz and make sure peripheral arterial disease doesn’t stop you in your tracks. 1. I am under 50 years of age, have diabetes and at least one other risk factor: a. History of smoking b. Abnormal cholesterol c. High blood pressure 2. I am 50 years or older and have diabetes 3. I am 50 years or older and am a former or current smoker 4. I am 70 years or older 5. I have one or more symptoms of PAD: a. Fatigue, heaviness, tiredness or cramping in the leg muscles (calf, thigh or buttocks) that occurs during activity such as walking and goes away with rest b. Foot or toe pain at rest that often disturbs sleep c. Skin wounds or ulcers on the feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks) If you answered yes to one or more of the above questions, talk to your health care provider about being tested for PAD.

Let’s Talk


Peripheral Arterial Disease Article by: Jennifer Clark, PA-C, MPAS

Peripheral arterial disease is a very common condition affecting between 8-12 million Americans. This number is expected to increase even more so as our population ages. Interestingly, only about 15% of those people have been diagnosed with peripheral arterial disease (PAD), while many people continue to attribute their symptoms of leg pain to “old age.” So what is the big deal about PAD anyway? Why is this so important to prevent? The arteries in our body are responsible for carrying oxygen and nutrient rich blood from the heart and lungs to the rest of the body for the organs and tissue to use. PAD is a narrowing of the arteries which is caused by a build-up of plaque, a waxy material made up of cholesterol, calcium and fibrous tissue. When the arteries are narrowed, this decreases the amount of blood flow to the body. When we exercise our muscles demand more oxygen, and when the arteries have narrowing it prevents them from getting this oxygen they require. This can cause weakness or painful cramping in the hips, buttocks, thighs or calves that resolves with rest which is called claudication.

As the disease progresses people can develop severe symptoms such as rest pain or formation of ulcers to the legs and feet. Eventually this disease can progress to the point where the artery can become totally occluded and often times patients may require amputations. There are certain risk factors that make people more likely to develop PAD. This disease effects patients more commonly over the age of 50, in fact, the current statistics reflect 1 in every 20 adults over the age of 50 have PAD. Smoking or a history of smoking increases the risk of developing this condition by four times! Diabetes is a condition where the body cannot use sugar or glucose appropriately therefore there are elevated amounts of glucose in the blood. This causes the walls of the artery to become rough, which allows for plaque to form and build up within the artery. High blood pressure has a similar effect on the walls of the artery. Blood pressure is a measurement of the amount of force the blood pushes against the artery walls, the higher the blood pressure the more damage to the walls of the artery which allows for the plaque to build up. Uncontrolled cholesterol is a risk as well. Your body makes both good and bad cholesterol. LDL, also known as the “bad cholesterol” is a particle

that carries cholesterol in the blood and deposits it in the arterial walls. The good cholesterol (HDL) helps to pick up excess plaquing from the artery walls. By understanding this you can see how if you have an elevated LDL and a low HDL this promotes plaque formation within the arteries. If you have any of the above mentioned risk factors or if you are experiencing symptoms of claudication then you should make an appointment with your primary care provider for further evaluation and treatment. Treatment for PAD begins with modifying risk factors such as the ones listed above. Controlling your cholesterol, Diabetes, and high blood pressure helps stabilize and improve arterial disease. Healthy diet and exercise along with stopping smoking benefits your body in so many ways. Walking programs often help improve the symptoms of PAD by promoting increased circulation. Various medications are also available to help improve symptoms. Interventional treatment with athrectomy and angioplasty may be required as well. PAD is a lifelong disease process, but early intervention and prevention can significantly improve quality of life. Knowing about risk factors and symptoms will help to identify this condition sooner so that treatment can be initiated sooner.



Electronic Cigarettes Article by: Clark Stream, PA-C


here is a new product on the market that has been changing the way people smoke. It’s called the “e-cig”. This new device consists of a battery, an atomizer (heater), and a cartridge that is filled with a liquid nicotine solution called eliquid. Every time you take a puff, the battery powers the atomizer which rapidly heats up the eliquid inside the cartridge. The liquid turns into a vapor that the user inhales. The vapor is tar free, odorless, 2nd hand smoke free, and carbon monoxide free. May manufacturers of this product claim the e-cigs as a revolutionary development for smokers that allow a customizable smoking experience. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. The FDA is concerned about the safety of these products and how they are marketed to the public,” said Margaret A. Hamburg, M.D., commissioner of food and drugs. ENDS are not approved by the FDA as smoking cessation devices.

Can e-cigs help you stop smoking? Over the years, several of my friends and family members have tried everything from patches, prescriptions, quitting cold turkey and plenty of nicotine gum. Unfortunately, very few have become non-smokers. For years working in cardiovascular and vascular surgery, I have preached to the smoking patient how important it is to stop smoking. Will e-cigs become one of the many tools used to help patients stop smoking? Findings suggest that e-cigarettes may hold promise as a smoking-cessation method and that they are worthy of further study using more-rigorous research designs. The reason I am writing about this topic …I was recently surprised when my mother and sister told me they were able to quit smoking with the help of the e-cig. I asked them how difficult it was to stop and they said with the e-cig, it was easy. This is an answered prayer.



A recent internet survey in 2010 was conducted to assess the profile, usage patterns, satisfaction and perceived effects among users of electronic cigarettes (“e-cigs�). Visitors of websites and online forums were dedicated to e-cigarettes and to smoking cessation. There were 3587 participants (70% former tobacco smokers, 61% men, mean age 41 years). The median duration of electronic cigarette use was 3 months, users drew 120 puffs/day and used 5 refills/day. Almost all (97%) used e-cigarettes containing nicotine. Daily users spent $33 per month on these products. Most (96%) said the e-cigarette helped them quit smoking or reduce their smoking (92%). Reasons for using the e-cigarette included the perception it was less toxic than tobacco (84%), to deal with craving for tobacco (79%) and withdrawal symptoms (67%), to quit smoking or avoid relapsing (77%), because it was cheaper than smoking (57%) and to deal with situations where smoking was prohibited (39%). Most ex-smokers (79%) feared they might relapse to smoking if they stopped using the e-cigarette. Users of nicotine-containing e-cigarettes reported better relief of withdrawal and a greater effect on smoking cessation than those using non-nicotine e-cigarettes. Conclusions of this survey showed that e-cigarettes were used much as people would use nicotine replacement medications: by former smokers to avoid relapse or as an aid to cut down or quit smoking. Further research should evaluate the safety and efficacy of e-cigarettes for administration of nicotine and other substances, and for quitting and relapse prevention.

What products should people who want to quit smoking use? There are a number of FDA-approved smoking cessation aids, including nicotine gum, nicotine skin patches, nicotine lozenges, nicotine oral inhaled products, and nicotine nasal spray that are available for smokers to use to reduce their dependence on nicotine. Free help is available to all smokers who want to quit at 1-800-QUIT-NOW or by visiting www.smokefree.gov4. Florida has several web sites including,,, or .



Restless Leg Syndrome: Everything you need to know from symptoms to soap Article by Jennifer Clark, PA-C, MPAS


o you ever complain of an uncontrollable urge to move your legs? Or perhaps you feel what may be described as a gnawing, or pulling, maybe even a creepy, crawly sensation in your legs that seems to happen when you rest? Does it seem to improve with movement? If so, you may be suffering from Restless Legs Syndrome (RLS), a condition affecting 1 in 10 Americans. Many people suffer from these symptoms but don’t realize that it is in fact a known medical condition. There is a significant amount of research out there looking for the cause of this condition, and it has not been nailed down to one particular cause. It has been found to run in families, and seems to affect women more than men, especially during pregnancy. There is thought that it is also due to an imbalance of a substance called dopamine, which is a chemical that is responsible for transmitting signals between the nerve cells in the brain. Anemia and low iron levels can also make these symptoms worse. Certain medications such as antihistamines, calcium channel blockers (used to treat high blood pressure and heart disease), and antidepressants can also provoke the symptoms. Interestingly, research has also found that a large number of patients who suffer from RLS have an underlying venous disease such as venous insufficiency where the valves in the veins are not working correctly. The patients that seem to be impacted the most by both conditions are very similar: women, individuals over 50 years old, people who have standing professions, obese individuals, and those with a family history of the condition. In our practice we have found that 80-85% of the patients that complained of symptoms of RLS improved significantly after treatment of their venous disease. By meeting with your primary care provider and discussing your symptoms he or she can review your symptoms, medications and lifestyle habits to help make the diagnosis and search for a possible underlying cause. Simple blood work can determine if you have conditions such as anemia or iron deficiency.



Treatment for RLS ranges from treating the underlying cause, lifestyle changes, to medications and even surgical intervention to correct venous insufficiency. Here are some lifestyle changes you can try to help alleviate your symptoms:

• •

• • • • •

Keep a regular sleep schedule. Fatigue often makes symptoms of RLS worse. Try to go to bed and wake up the same times during the day to help your body get into a routine. Also avoid falling asleep with the television or lights on. Compression hose • Wearing during the day when you are on your feet can help improve your symptoms, especially if you have underlying venous disease • Exercise in moderation • By maintaining aerobic fitness symptoms often improve, however intense or extensive training such as running a marathon can sometimes provoke symptoms • Article continued on the back • Stop smoking and drinking alcohol Cut back on caffeine Take a multivitamin Often deficiencies in magnesium, iron, folic acid, and vitamin B can cause symptoms of RLS Weight loss Yoga

Lastly, I would like to leave with you with an anecdotal remedy. I will forewarn you, as I do with all of my patients I tell this to in clinic, that it may sound ridiculous! Are you ready? Place a bar of colored soap at the foot of your bed underneath your fitted sheet. Some people have even placed a small bar of soap, similar to the size you find in hotel rooms, in each sock when they sleep. It is not known how or why this works, but we have found that 70-80% of our patients that try it notice significant improvement of their symptoms. I always say, as silly as it sounds, it is certainly worth the cost of a bar of soap to try!

Vascular Insights Issue #4  

In this issue: - Early Diagnosis is Key - Let's Talk about PAD - E-Cigarettes - Restless Leg Syndrome

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