Stay In The Game Kingdom magazine has teamed up with the Cleveland Clinic Foundation (CCF) to offer health information important to everyone who loves to golf (and that’s basically all of us). In this installment, CCF tells us that what you thought was just leg pain could signal a condition called PAD—not a good thing. Fortunately, PAD is treatable. The experts at CCF explain… The 63-year-old lifelong golfer suddenly announced, “I’m giving up the game.” His friends and family were stunned. Although the ex-golfer offered no explanation for his decision, his doctor suspected there might be some serious physical problem. Indeed, it turned out that the man was experiencing leg pain—but not the usual muscle ache. It was pain that came on whenever he walked, and stopped when he stopped walking. The pain had leached so much pleasure from the game, that the golfer saw no recourse but to banish his clubs to the closet—for good. To vascular specialists at the Cleveland Clinic Miller Family Heart & Vascular Institute, the patient’s condition would be no mystery. Cleveland Clinic has treated thousands of patients who have similarly experienced pain while walking that goes away with rest. It is sometimes the first symptom of a serious condition known as peripheral arterial disease, or PAD. What’s sad about PAD is how little respect it gets. Too often, doctors don’t recognize it or they undertreat it. The patient pays for this neglect, sometimes with an arm or a leg. Doctors are recognizing that PAD is a much more common problem than originally thought. Up to one in five people older than age 70 have PAD. Fewer than half of the patients with PAD know they have a problem. PAD is like coronary artery disease or atherosclerosis. It’s a blockage of the arteries. Only it doesn’t happen in the heart, it happens in the arteries that carry blood to the arms or legs. Well, sometimes you get leg pain…
kingdom
20
summer
2011
PAD is tricky. Only about 10 percent of patients actually have claudication. Some 50 percent report something more like fatigue, numbness, tightness or heaviness in the limb. Forty percent don’t mention leg problems at all (although they may have a mobility problem that prevents them from using their legs very much). Like coronary disease, you can have a severe case without serious symptoms. What causes PAD? The conditions that increase the risk of PAD are the same risk factors that increase the risk of heart attack or stroke. These include age, diabetes mellitus, and cigarettes (smoking is the leading risk factor for PAD). Other factors include diabetes, high blood pressure and high cholesterol. Fortunately, there’s a good test for PAD. It’s called the ankle brachial index, or ABI. Your ABI is derived from blood pressure readings in the ankle and leg, taken while resting and lying down. Sometimes these blood pressure readings are repeated after a period of walking on a treadmill. The 63-year old golfer had an ABI of .078 at rest. Mild disease. Treatment follows diagnosis. Our patient didn’t need to quit golf. He needed to quit smoking. His one-packa-day habit had to be reduced to no-pack-a-day. In many patients, losing the cigarettes means improving the claudication. There are currently two medications available in the United States to treat claudication. Patients with PAD also need to work on their risk factors for heart attack and stroke, and that generally includes cholesterol lowering medication, antiplatelet
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