Dear Dr. Donohue: Since January, when I made a New Year's resolution to be more active, I have been walking daily, seven days a week. In the past month, I have pushed to walk farther and faster. I began to have pain in my right calf, so I had to slow it down again.
Does this sound like arthritis to you? It runs in my family.
B.R.
It sounds more like peripheral artery disease, PAD, a condition that five per cent of adults over 40 and 20 per cent of those over 70 have. Peripheral artery disease is the same process that occurs in heart arteries, an obstruction to blood flow due to the buildup of cholesterol and fat on the artery wall. In the heart, it causes the chest pain of angina when a person engages in physical activity. In the legs, it causes pain in the buttocks, thighs, calves or feet when a person walks farther than usual or faster than usual. The leg muscles are not getting the amount of blood they need to support such exertion.
An easy test, done in the doctor's office, provides solid evidence for the diagnosis of PAD. That test entails taking blood pressure in the arm and comparing it with blood pressure in the leg. The name of the test is the Ankle-Brachial Index, dividing the ankle pressure by the arm pressure. A number less than 0.9 denotes peripheral artery disease. Taking the ankle blood pressure requires a special instrument, one that's not available to the public. Most doctors have it.
PAD is treated much like plugged heart arteries are treated. Keep up your walking program, and do try to increase the length and pace of your walk. Stop to rest if pain occurs, then resume walking when it leaves.
Your doctor will decide if you need a medicine like Pletal (cilostazol).
For large obstructions, procedures similar to ones used to open heart arteries (balloon dilation, grafts, stents) are used for PAD.
Also important is an examination of your heart's circulation.
People with PAD often also have coronary artery disease (CAD), plugged heart arteries.
Dr. Donohue regrets he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Write him at P.O. Box 536475, Orlando, FL 32853-6475.
