DEAR DR. DONOHUE: I am a 74-year-old male and have been diagnosed with peripheral artery disease, PAD. I have a complete occlusion of the main artery just above the knee. What, in your opinion, are the chances of getting through the blockage with angioplasty? There is constant soreness in my calf, even at rest. Is that caused by the blockage? Will cilostazol (Pletal) and Crestor possibly dissolve some of the blockage? — J.C.

ANSWER: Peripheral artery disease, PAD, is also called peripheral vascular disease. It’s an obstruction to the flow of blood through a leg artery. The obstruction is a buildup of cholesterol, fats and various other blood elements. Between the ages of 60 and 65, 4 percent of adults have it, and by the time people reach 80, 20 percent or more are victims of it.

Its chief sign is intermittent claudication, which is pain in leg muscles, quite often the calf muscles, when a person is active. Many can predict almost to a specified number of steps when the pain will arise. Once the person rests, pain usually lasts minutes, but it can take 20 or more minutes to leave. It returns when the person begins to walk again. I can’t say definitely if your constant calf pain is due to PAD; it might be.

Ankle blood pressure is a valuable test for detecting PAD. Normally, the ankle pressure should be close to the arm blood pressure. A lower ankle pressure indicates an obstruction in a leg artery.

Your medicines cilostazol and Crestor won’t completely dissolve the buildup in your leg artery, but they’ll keep it from growing larger. Crestor might reduce the size somewhat. You can help matters by watching your cholesterol; eating a diet that emphasizes grains, fruits and vegetables; controlling your blood pressure; and controlling your blood sugar if you have diabetes. Walking is an exercise that is most helpful.

Angioplasty is one option for you. It will get through the buildup. It’s the same procedure used to open heart arteries with a balloon-equipped catheter that is threaded to the blockage through a surface artery. The balloon is opened at the obstruction, and often a stent is left in the artery. A stent is a wire device that keeps the artery opened. Surgical replacement of the clogged segment of artery with a graft is another option. The location and extent of disease determine which is the better choice.

The booklet on PAD explains this common condition in detail. To obtain a copy, write: 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: What is the purpose of making all Coumadin users make a separate trip to a nurse for having their blood checked? It’s an additional charge that I cannot afford. Is there any other drug I could use? I am 93. — R.J.

ANSWER: I imagine the procedure was instituted so the nurse can change your dose of Coumadin right away if the blood tests indicate that your blood is too thin or too thick. Coumadin is an anticoagulant that stops clots from forming; it really does thin blood. The medicine is prescribed when a person has a condition where clots form and might cause a stroke. Atrial fibrillation is such a condition.

You can ask your doctor if you’re a candidate for the new anticoagulant Pradaxa. With it, you don’t need to have the same blood checks required when you take Coumadin.

DEAR DR. DONOHUE: Regarding the item on Coumadin and cranberry products, I enclose the dosing card provided to all patients I see in the clinic where I work. It advises people not to use cranberry juice. — L.W.

ANSWER: If people moderate the amount of cranberry juice they drink, they won’t get into trouble with their Coumadin blood level. “Moderation” means 2.5 cups a day.

The Food and Drug Administration insists that Coumadin manufacturers include the cranberry advice in their inserts. No solid evidence supports the warning. Several well-conducted studies have failed to show any interference of cranberry juice with Coumadin.

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

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