Leg pain, a sign of artery disease

DEAR DR. DONOHUE: About four to six months ago, you wrote about pain in the calves. I suffer from this problem. Would you repeat the information for me? — V.G.

ANSWER: The topic was peripheral artery disease, also called peripheral vascular disease. “Periphery,” when used here, refers to the arms and legs (mostly the legs). The buildup of plaque — cholesterol, fats and other materials — within leg arteries obstructs the flow of blood to leg muscles. The result is pain on exercise, since exercise requires an increased blood supply. Obstructed arteries can’t provide it. It’s as though a tight tourniquet is tied around the legs.

Pain arises in areas downstream of the obstruction. If an artery high up in the legs is blocked, then the pain is felt in the buttocks, hips or thigh. If the obstruction is lower in the thigh, pain is felt in the calves, and that’s where many patients have their pain. Obstruction in arteries lower in the legs brings foot pain.

When doctors examine the legs of people with peripheral artery disease, they can’t feel a pulse, as they can in normal people’s legs. One good test is blood pressure measurement at the ankle. Ordinarily, it should be the same as blood pressure in the arm. If ankle blood pressure is much lower than arm blood pressure, that’s evidence of leg artery obstruction.

The same kind of diet that people with blocked heart arteries follow should be the kind of diet for those with peripheral artery disease — one low in fat, high in grains, fruits and vegetables, and low in red meat. An exercise program is essential. People start out modestly by walking for five or 10 minutes. Walk to the point of pain, stop and then start again when the pain leaves. Progressively increase the time and pace of the walk. Aspirin, Pletal and Plavix are medicines frequently prescribed for this condition. Blood pressure and cholesterol have to be controlled. Procedures that replace the obstructed artery with a graft or open it with a balloon also are available.

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The booklet on peripheral artery disease discusses this topic at greater length. 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. Allow four weeks for delivery.

DEAR DR. DONOHUE: Please give me an answer. My son has had a lot of heart problems. He has a pacemaker and a defibrillator implanted in his chest. He passed out once and fell. When they checked, they said he had died and his defibrillator brought him back to life. How will he ever die if his defibrillator keeps working? It starts his heart again. — L.A.

ANSWER: A defibrillator doesn’t bestow immortality. It can end lethal heart rhythms, and it can jump-start a heart that has suddenly stopped, but it cannot keep a worn-out heart beating forever. People who have a defibrillator eventually die just as you and I will. They die from a heart that can no longer pump or from cancer, kidney failure, emphysema, infections and on and on — the same kinds of things we without a defibrillator face.

DEAR DR. DONOHUE: Will you please discuss my problem of yawning way too much even though I have had enough sleep? I have asked four or five doctors, but they just say I am bored. That’s completely incorrect. — C.A.

ANSWER: Yawning isn’t my favorite subject. Information on it is sorely lacking.

It is associated with boredom and sleepiness, but not always. One suggested explanation is that yawning cools the brain. Does this sound as strange to you as it does to me? At any rate, the people who propose this theory say that ice applied to the head stops a person from yawning. A previous explanation was that it supplied the brain with oxygen. That isn’t true. It does keep the lungs’ air sacks (alveoli) open, and it might be a reflex to promote this action.

I believe it is just one of life’s mysteries. You can suppress a yawn if you catch it early. It won’t hurt you to do so.

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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