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Living With Peripheral Artery Disease: Early Signs, Lifestyle Tips, and Modern Treatments · Flourish- A Prisma Health Podcast

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  ph145retrack_Joey_Wahler_raw audio_2.10:
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  can cause significant circulation issues, so we're discussing peripheral
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  arterial disease, also called PAD.
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  Joey Wahler (Host): Our guest is Dr.
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  Ser Gandhi.
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  He's a vascular surgeon.
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  This is Flourish, the podcast from Prisma Health.
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  Thanks so much for joining us.
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  I'm Joey Wahler.
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  Hi, Dr.
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  Gandhi.
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  Welcome.
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  Dr Sagar Gandhi: Hey, thank you so much for
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  having me.
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  Joey Wahler (Host): Thank you so much for making the time.
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  First, simply put, for those unfamiliar, what is PAD,
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  Dr Sagar Gandhi: PAD is, peripheral arterial disease, as you said,
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  and basically it's blockages in the leg arteries that blood
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  from getting down to the feet.
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  Joey Wahler (Host): And so what would be the symptoms of this?
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  Dr Sagar Gandhi: Yeah, so most of this goes undiagnosed until
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  it's in its later stages.
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  But the first symptoms people can have is anywhere from muscle
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  cramping or your muscles wearing out, especially when you walk or, or a run.
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  And then also you can even present with a wound on your foot that's not healing.
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  Joey Wahler (Host): So why the feet?
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  Dr Sagar Gandhi: Well, so if you think of it, the blood comes down
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  from the heart And the feet are really the farthest thing from it.
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  And so, if you have multiple blockages or even a long segment blockage, you
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  have trouble getting the blood down to the farthest part, from your heart.
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  Joey Wahler (Host): Certainly makes sense.
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  So because of the fact that, as you said, there are typically no symptoms
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  until this thing has progressed, that makes risk factors more
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  important for people to be aware of.
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  Right.
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  Dr Sagar Gandhi: you're absolutely right.
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  So things like.
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  controlling your blood sugar if you have diabetes, stopping smoking,
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  getting out and exercising, controlling your cholesterol levels.
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  All those things help reduce, the chances of PAD.
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  Joey Wahler (Host): So someone that's overweight, especially significantly,
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  so someone that's diabetic, how much more likely would they be to get this.
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  Dr Sagar Gandhi: Unfortunately, they're a lot more likely,
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  I would say up to 30 to 50%.
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  Joey Wahler (Host): And so what are the things that people need to be mindful
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  of if they're in that risk factor category, to try to keep this at bay?
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  Dr Sagar Gandhi: So I think the big thing is to pay attention to symptoms.
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  if you're having that leg pain while you walk.
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  especially in the muscles, if you have a foot wound that's not healing.
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  Something as simple as just checking your feet daily, because unfortunately,
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  as you said, diabetics tend to get PAD and they tend to get foot wounds.
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  They also get neuropathy where they can't feel their feet or feel
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  their toes, And so they can get a small cut and not even realize it.
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  But the biggest thing you can do is just try to live a
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  well-balanced, healthy lifestyle.
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  Joey Wahler (Host): Absolutely.
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  So how is PAD diagnosed by someone like yourself?
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  Dr Sagar Gandhi: So typically when you come in and you have some of these
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  symptoms, we first start by doing a physical exam, which is just simply
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  checking pulses in the groin area on the top And the side of your foot.
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  if we feel some diminished pulses or we don't feel pulses
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  there, we can get a simple.
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  Ultrasound or even, we can measure blood pressure in your feet compared
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  to your arms, which will give us an indication on percentage blockage.
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  Joey Wahler (Host): And so are there situations where.
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  The pulse is at a healthy level in one part of the foot, not so in another.
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  Dr Sagar Gandhi: Absolutely.
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  If you think of your blood vessels, just like plumbing and
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  pipes, you can have good pressure.
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  And then downstream, if you have a blockage.
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  on the other side of that blockage, you don't have a good
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  pulse because the pressure is so
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  low.
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  Joey Wahler (Host): Gotcha.
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  And so how is this typically treated?
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  Dr Sagar Gandhi: So typically, first thing is lifestyle modification, like
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  we talked about, risk factor control.
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  stop smoking.
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  get your blood sugar under control, control your cholesterol.
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  That'll prevent the disease from getting worse.
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  We start out by people on a supervised exercise plan that can improve their
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  walking distance and actually help reduce the pain they have when they walk.
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  Now if you present with more severe peripheral arterial disease,
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  like a foot wound, at that point, we need to be more aggressive.
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  Things like, doing endovascular interventions like balloons or
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  stents in the legs to, reopen the blockages, or even if it's a long
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  segment, potentially a bypass.
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  Or surgery to clean out that artery.
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  Joey Wahler (Host): And so how do you go about determining which treatment
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  is best in a particular case?
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  Dr Sagar Gandhi: Well, I think based on the level of symptoms you're
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  having, so if you present with severe peripheral arterial disease like
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  a foot wound, that's not healing.
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  We've gotta pull out the bigger guns, And that typically means some
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  sort of procedure, like a stent.
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  Or even a bypass.
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  If you come in with milder symptoms and we've caught it early, we can put you on
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  a supervised exercise plan, potentially give you some medication that will
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  improve your blood flow, And we can prevent the progression of the disease.
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  Joey Wahler (Host): So when you talk about progression, at what point
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  does this start to become alarming?
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  Dr Sagar Gandhi: Well, it depends on your definition of alarming.
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  So if you're a businessman who has to walk through the airport to get from,
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  the terminal to another terminal, and you can't make that walk 'cause your legs
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  squid on you and you're missing flights, or if you work in a warehouse and you
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  can't walk from one side of the warehouse to the other, that can be alarming.
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  That puts your livelihood at-risk.
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  of course, when you talk about limb loss, meaning you'll lose
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  your leg or lose your foot.
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  That's when you get the, foot wounds that aren't healing, Those
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  are at-risk of having limb loss
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  Joey Wahler (Host): And I am gonna ask you more about that in just a moment.
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  But first, when This is treated, is the goal to reverse it or simply to manage?
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  Can it be reversed?
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  Dr Sagar Gandhi: So I think both depending on the presentation.
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  So first and foremost, we want to manage and prevent progression of
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  peripheral arterial disease, And that would be the medical management And the
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  lifestyle modification we talked about.
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  But if you show up with more severe disease, like a foot wound, we need
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  to put a stent in, do a bypass, and.
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  Basically reverse some of the effects.
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  Now, unfortunately, or fortunately, our bypasses are heavily dependent
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  on how the patient chooses to live their life moving forward.
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  Meaning, if you continue to smoke and your blood sugar is still bad,
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  then whatever we do is not going to be effective in the long-term.
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  Joey Wahler (Host): Now when you talk about some of those things that you
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  mentioned in terms of lifestyle changes, diet and exercise in particular.
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  In addition, there are some home remedies, if you will, right?
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  Like.
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  Tell us about elevating the legs, how can that help?
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  Dr Sagar Gandhi: so leg elevation is really good for venous disease,
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  especially if you have chronic leg swelling and you have varicose veins
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  for peripheral arterial disease.
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  It may not be the best, especially if you have more severe
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  peripheral arterial disease.
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  Joey Wahler (Host): And then what about applying heat to the feet?
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  Dr Sagar Gandhi: So I think heat can be nice, especially it can help with some
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  of the discomfort that you're feeling.
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  But typically heat is good for arthritis type of pain.
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  a lot of diabetics get peripheral arterial disease, and as I said earlier.
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  They may not be able to feel that temperature on their legs and actually
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  can burn some of their skin So, It could actually be detrimental.
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  Joey Wahler (Host): So I wanna go back to.
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  Diet and exercise.
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  If people listening are affected by this and wanna make just one change
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  in their diet to get started down that road, what would you recommend?
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  Dr Sagar Gandhi: I think avoid fried foods.
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  I think that grilling, baking, things like that are much
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  better than frying your foods.
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  You know, try to reduce the amount of oil and butter that you use.
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  And I think that'll make a huge
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  difference.
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  Joey Wahler (Host): That's a really great.
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  Piece of advice.
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  And how about in terms of exercise?
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  Kind of same church, different pew here as they say.
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  Doc, if someone wants to just do one thing to get started with being
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  more active, being more mobile, to increase the circulation in
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  those feet, what should they do?
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  Dr Sagar Gandhi: It something very simple.
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  Just walk.
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  And by that I mean intentional walking.
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  Either walk around your neighborhood, walk around the track, at your local
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  park, take your dog for a brisk walk.
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  I think the intentional walk is really the most important thing, and by intentional,
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  I mean walk for the sake of walking.
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  People tend to go to the grocery store and they say, oh, I
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  walk the whole grocery store.
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  But if you think about it, you stop every aisle or two and, grab something or look
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  at something, what you really want to do.
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  Is walk and exercise, meaning go ahead and turn a stopwatch on, figure
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  out how long you can walk, walk a mile, walk five minutes, whatever
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  you can do, And then just try to slowly increase that walking time and
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  walking distance over the next several
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  weeks.
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  I
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  Joey Wahler (Host): Yeah, you wanna walk like you are late for an
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  appointment as opposed to walking like you're taking a stroll in the park.
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  Couple of other things.
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  How about vitamins or supplements?
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  Can they be
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  helpful here?
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  Dr Sagar Gandhi: Yeah, I think just having a well balanced diet and, anything
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  your primary care says you need, such as magnesium can help some of the cramping.
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  staying well hydrated is probably the most important thing you can do if you have
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  even mild peripheral arterial disease.
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  Joey Wahler (Host): Now I saved the most potentially unpleasant subject
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  here for toward the end of our chat.
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  You touched on it earlier, losing a limb, losing a foot because of
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  this condition becoming so bad.
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  Can you talk to our audience about.
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  Just how important it is to stay on top of this.
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  Try to ward it off.
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  Try to heed these warnings that you're giving
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  to make sure it doesn't come to that.
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  Dr Sagar Gandhi: Yeah, so unfortunately if you do have severe PAD and you
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  develop a foot wound, you risk of losing that limb is greater than 30%.
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  More importantly, This is a check engine light, so to speak, meaning
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  that you're not living your life right.
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  And you're not having a healthy diet and really you have another 30% chance
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  of having some sort of cardiovascular meeting, a heart attack, or a stroke,
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  or even dying in the next year.
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  So preventing it from getting to that point is really important,
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  but once you notice you
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  have it, seeking medical attention
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  quickly is also very important to try to halt the progression.
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  Joey Wahler (Host): And along those lines,
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  doctor in summary here.
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  It seems the advice you're giving isn't just about dealing with this
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  condition, but through osmosis.
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  If you do the things you need to, to ward this off, you'll be living a
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  healthier lifestyle overall.
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  Right.
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  Dr Sagar Gandhi: Absolutely vascular surgery is a surgical
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  treatment of a medical problem.
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  Your medical problems have gotten so bad
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  now they're starting to manifest in different parts of your body,
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  namely for PAD in your legs.
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  Joey Wahler (Host): Well folks, we trust you are now more familiar
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  with peripheral arterial disease.
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  Dr.
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  Gandhi, keep up all your great work valuable information
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  indeed, and thanks so much again.
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  Dr Sagar Gandhi: Thanks again.
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  for having me.
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  Joey Wahler (Host): Absolutely, And for more information, please
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  visit prisma health.org/flourish.
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  If you found this podcast helpful, please do share it on your social
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  media and be sure to explore our entire podcast library.
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  For topics of interest to you, I'm Joey Wahler and thanks again for being part of
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  Flourish The podcast from Prisma Health.