DEAR DR. DONOHUE: My wife’s doctor thinks she has intermittent claudication due to peripheral vascular disease. She also has diabetes. Would you describe it and its treatment? — S.B.
ANSWER: Peripheral vascular disease also goes by the name peripheral artery disease, PAD. “Peripheral” refers to the outer boundary, and when speaking of the body, the legs are its periphery. Leg arteries are narrowed and often blocked by the buildup of cholesterol, fat and many other components found in the circulation. The buildup is called plaque. The buildup can be so great that no blood runs through the main leg arteries.
Intermittent claudication is leg pain that develops when someone with PAD walks any distance. The person can tell, almost to the number of steps taken, when pain will arise. Taking a rest relieves the pain.
About 15 percent of those 70 and older have PAD. Its main sign is intermittent claudication.
Your wife can do many things on her own that will help her. If her cholesterol is high, she has to get it down. She has to maintain normal blood pressure. She must exercise within the limits prescribed by her doctor. Walking is one of the best exercises. If she starts out modestly and gradually increases the distance and pace, she should aim for 30 minutes of walking daily. When pain arises, she should stop, take a break and then resume once pain has gone.
One simple test for determining PAD is comparing blood pressure taken at the ankle with blood pressure taken in the arm. They should be nearly equal. If the ankle pressure is lower, that’s evidence of PAD.
Your wife’s doctor will discuss the use of medicines like Plavix, Pletal and aspirin. With severe blockage of an artery, opening it up with a balloon-tipped catheter and inserting a shunt is one treatment. It’s the same procedure used for clogged heart arteries. Removing the obstructed artery segment and replacing it with a graft is another way to treat this illness.
The booklet on PAD discusses the details of this common malady in depth. Readers can obtain a copy by writing: Dr. Donohue — No. 109, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: Ever since I was 10 years old, I have had this problem: If I set something down or reach or touch something, I have to touch it again to make it feel right. When I hang clothes, I reach for a hanger and then put it back for a different one. I do things like this all day. I am 55. Am I crazy? — N.H.
ANSWER: You describe obsessive-compulsive disorder. You’re not crazy. Many people have it. It’s an irresistible urge to perform a certain ritual, like touching things a second time or constantly washing the hands. That’s the compulsion, an act that relieves inner unease, the obsession.
Help is available. Ask the family doctor to refer you to a specialist in this disorder. You’ve put up with it for too long.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.