Poor leg circulation can cause calf pain

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DEAR DR. DONOHUE: I think my circulation is bad. When I walk from my car in the parking lot to the grocery store, my calves hurt. It’s not a cramp. I have to sit on a bench for a couple of minutes and then I’m OK until I walk one or two aisles in the store. What do you think this is, and what can I do for it? – R.B.

ANSWER: I agree with you. I think it’s a circulation problem too. The calf pain you describe is intermittent claudication – pain and fatigue that come on while walking and disappear with a couple of minutes of rest. It’s a sign that the leg muscles aren’t getting enough blood. Leg arteries are clogged with a buildup of fat, cholesterol and platelets – plaque. The condition is called peripheral vascular disease. Another name is peripheral artery disease. “Periphery” here refers to the legs.

If the obstruction in the leg artery is up high in the artery, above the thighs, the pain is felt in the hips, buttocks or thighs. If it’s at thigh level, the pain is felt in the calves. If it’s lower down, then walking brings on pain in the feet. Resting always relieves the pain.

Diabetes, high blood pressure, high blood cholesterol, aging and cigarette smoking are things that foster peripheral vascular disease – the same things that foster clogged heart and brain arteries. Peripheral vascular disease, therefore, takes on added significance, for it often indicates heart and brain arteries are similarly affected.

Your doctor has to examine you. A simple test is to measure blood pressure in the ankles and in the arms. They should be equal. If the arm pressure exceeds the ankle pressure, that’s good proof that leg arteries are obstructed.

Treatment is likely familiar to you. Lower blood cholesterol; keep blood pressure in the normal range; control blood sugar if diabetic; lose weight if necessary; start a walking program and walk to the point of pain, rest and then resume walking. Aspirin or Plavix can improve circulation.

Surgery on or the placement of a stent in the obstructed artery might be indicated.

The booklet on peripheral vascular disease treats this subject in great detail. 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./6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Can an overactive thyroid gland raise blood calcium? I have a thyroid condition, and my calcium is above the norm. Can my condition or the medicine for it cause this? – T.R.

ANSWER: High blood levels of thyroid hormone can raise blood calcium a bit, but not usually to a point where it causes any symptoms. I can’t implicate thyroid medicine for an overactive gland as a possible cause.

Overactive parathyroid glands can definitely raise blood calcium levels. The parathyroid are four small glands that adhere to the back of the thyroid gland.

DEAR DR. DONOHUE: What is referred pain? I have had pain in my right shoulder blade, off and on, for about six months. I thought I had strained a muscle. My doctor believes it comes from my gallbladder, and I am scheduled to have an ultrasound of it. Can the gallbladder cause shoulder-blade pain? How? – M.M.

ANSWER: Referred pain is pain felt in a place distant from the actual source of the pain.

Gallbladder pain is a good example. The gallbladder is beneath the liver on the upper right side of the abdomen. However, a gallbladder attack can be felt in the right shoulder blade or in the area between the shoulder blades.

The explanation has to do with where organs are located during fetal life. Organs and tissues far removed from each other in a mature baby are close to each other in a fetus. As maturation progresses, the organs migrate from their fetal position to their full-term maturity position. But they carry with them the same nerve connections they had from the beginning. So nerves adjacent to the fetal site of organs can become activated after that organ has relocated to its normal, fully developed position.

DEAR DR. DONOHUE: Would you address plantar warts? I’ve been told they’re from a virus in the body and that nothing can be done for them or keep them from recurring. Is this so? – D.W.

ANSWER: All warts, wherever they are, come from an infection with one of the more than 100 human papillomaviruses – HPV. Individual members of the HPV family have a preference for particular body sites. Some head for the soles of the feet to cause plantar warts. “Plantar” is derived from a Latin word meaning “sole of the foot.”

If a plantar wart isn’t kicking up a fuss, it can be left alone. It’s not going to do any harm. Many such warts disappear without any treatment. Some can return, and there is not a whole lot to do about preventing a second visit. However, there is much to do about a plantar wart that hurts. The method chosen for wart removal must not leave a scar. A scar on the bottom of the foot causes more trouble than does a wart.

Look on the shelves of any drugstore for wart-removal products that contain salicylic acid, and follow the directions for application carefully. Be patient. It takes more than one application to get rid of the wart.

Duct tape sometimes works. That’s right – duct tape, the tape you buy in a hardware store. Cover the wart with a piece of it for six days. Remove the tape, soak the foot and then gently rub the wart with a pumice stone, obtainable in drugstores. Reapply the tape after 12 hours. You might have to repeat this procedure for two months before the wart leaves.

If home remedies bring no success, the family doctor can step in with more involved treatments.

As an aside, a new, not-yet-available wart treatment is HAMLET. It’s made with substances found in human milk. If and when it does come on the market, it is expected to be expensive.

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. Readers may also order health newsletters from www.rbmamall.com

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