Peripheral Arterial Disease & Tens

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I don't think a blockage in one leg would effect the other? But it's common to have problems with both legs, one worse than the other. Eg: I have a completely blocked left femoral artery, most of the way from groin to knee, and 50%+ narrowing (but not actual blockage) in the right. On CT angiogram imaging, I have a big twisty snaking bundle of collaterals bypassing the long, long left blockage and a couple of little collaterals doing a short bypass of the narrowing in the right. Without the blockage in the left leg I'd still feel the effects of the narrowing in the right, but as it is the bigger problem kind of masks the smaller one.

"Walking a lot": I've always enjoyed walking & so reaching the point where I could only do a couple of hundred metres before stopping was a big deal. Having worked out that walking is the best therapy for PAD, I started to really push things. By 12 months after diagnosis I was averaging around 8,000 steps per day; 11,000 by year 2.

At that point I'd achieved a lot of the collateral development & my vascular surgeon lost interest; no opportunity for him to wield a scalpel, I'd dealt with things as far as he was concerned.

The last two years I've averaged 14K steps per day and so far this year I'm averaging around 16K. Walking speed has also increased progressively: from < 100 steps/minute to 115-125 now.

I think maybe I grow collaterals more easily than lots of other people, or at least that's the sense I get from reading studies. In practical terms, it hurt like hell starting out, but I could see meaningful improvements in walking distance reasonably quickly, so the pain/gain picture was kind of favourable. But it seems to vary a lot from person to person.

Anyway, finding some activity you can build up, even if not walking, would I think give you more comfort that you have a level of control over things, in addition to just being generally good for your health and outlook.

Talking at you and not explaining things is nothing like the standard of care & in your position I'd really push for them to do a better job. They should be giving you a detailed explanation of the disease, what your situation is, why they are stenting, and what kind of risk factor modifications you should be lstriving for, and they should be giving you time and space to consider and ask questions. They should definitely be giving you advice about exercise, ideally referring to you a structured exercise program if available in your area.

But unfortunately inadequate care for PAD seems to be a general problem in lots of places, including here in Oz. It's seen as less serious than CAD, incorrectly, and not as sexy.

I found that educating myself about the disease was more useful than any advice I was getting from HCP's. You've probably been to the NHS site: https://www.nhs.uk/conditions/peripheral-arterial-disease-pad/treatment/ Being in Oz I get to pick & choose and I actually find that US guidance is usually more thorough and informative. This from the American Heart Association is a good starting reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000470

Best of luck! Let us know how you get on.
I should add that walking is great for the earlier stages of PAD but I'm not sure what the situation is when things have progressed to resting pain, and I don't think the guidelines are as clear. Your vascular consultant really should give you some guidance.

And another refererence - European Cardiology Society PAD Guidelines: https://academic.oup.com/eurheartj/article/39/9/763/4095038
 
Hi all , new to the site as of today. Am very likely to be diagnosed with peripheral arterial disease. I have worrying symptoms that have developed quite quickly, last few months but becoming worse over last week or two. Before this I was admitted to hospital because I had chest pain, swelling of legs feet and breathlessness. I have type two diabetes and high blood pressure- am on medication for both. Despite my blood pressure readings being high over last few weeks/month’s doctors did nothing, did not see me face to face, just prescribed medication… they knew I had a hereditary heart condition- hypertrophic cardiomyopathy- diagnosed in 2018 as mum has it. Even when my symptoms became severe- they still didn’t see me. Eventually spoke to a different doctor and she referred me urgently to cardiologist team at hospital- when I got there they knew nothing about my hereditary heart condition, nor about continued high blood pressure etc. they were horrified! I had scans/echocardiogram and it showed that I had further damage to my heart wall, plus complications of hypertrophic cardiomyopathy- as a result of untreated/managed existing conditions. So, now diagnosed temporarily with Atypical Angina until I have coronary CT at hospital and coronary MRI at Royal Brompton Hospital. They told me I could wear compression stockings and take Perindiprolol in addition to my regular medication. However! Since then the above PAD symptoms have progressed and I have spoken to Diabetes UK and they advised I get an urgent doctor appointment. I did and saw them next day, now due ANKLE TEST next week.

FINALLY! my actual question!

Can I wear compression stockings and also should I be taking Perindiprolol as it says on patient leaflet people with hypertrophic cardiomyopathy should not take it! I’ve tried to speak to cardiologist team but they said they can’t advise me, despite saying I could call them anytime for advice!
Also, what shoes should I wear at home? I am unable to elevate my legs above my heart as I have mobility problems. HOW and WHAT is the best way to sit at home?

THANK YOU!
 
Can I wear compression stockings and also should I be taking Perindiprolol as it says on patient leaflet people with hypertrophic cardiomyopathy should not take it! I’ve tried to speak to cardiologist team but they said they can’t advise me, despite saying I could call them anytime for advice!
Also, what shoes should I wear at home? I am unable to elevate my legs above my heart as I have mobility problems. HOW and WHAT is the best way to sit at home?
Hi! Apols, nobody here is qualified to give you advice about ACE inhibitors like perindopril. But a quick scan suggests to me that your question is totally valid & I really don't understand your cardio team saying they can't advise you?? Did you speak with an actual doctor or just a gatkeeper receptionist type?

What heart/blood pressure meds are you on at the moment - beta blockers?

I've never used compression socks & ditto comments about lack of qualifications, really - but also ditto comment about a quick scan suggesting that they could cause problems. Your cardio team really should be able to answer this type of simple question.

I suppose an easy way to elevate legs is just to put pillows or cushions under them?

Sorry not to be of much use, but anyway glad you're having the PAD possibility checked out. Hopefully you can get some better answers from some qualified HCP along the way.
 
I don't think a blockage in one leg would effect the other? But it's common to have problems with both legs, one worse than the other. Eg: I have a completely blocked left femoral artery, most of the way from groin to knee, and 50%+ narrowing (but not actual blockage) in the right. On CT angiogram imaging, I have a big twisty snaking bundle of collaterals bypassing the long, long left blockage and a couple of little collaterals doing a short bypass of the narrowing in the right. Without the blockage in the left leg I'd still feel the effects of the narrowing in the right, but as it is the bigger problem kind of masks the smaller one.

"Walking a lot": I've always enjoyed walking & so reaching the point where I could only do a couple of hundred metres before stopping was a big deal. Having worked out that walking is the best therapy for PAD, I started to really push things. By 12 months after diagnosis I was averaging around 8,000 steps per day; 11,000 by year 2.

At that point I'd achieved a lot of the collateral development & my vascular surgeon lost interest; no opportunity for him to wield a scalpel, I'd dealt with things as far as he was concerned.

The last two years I've averaged 14K steps per day and so far this year I'm averaging around 16K. Walking speed has also increased progressively: from < 100 steps/minute to 115-125 now.

I think maybe I grow collaterals more easily than lots of other people, or at least that's the sense I get from reading studies. In practical terms, it hurt like hell starting out, but I could see meaningful improvements in walking distance reasonably quickly, so the pain/gain picture was kind of favourable. But it seems to vary a lot from person to person.

Anyway, finding some activity you can build up, even if not walking, would I think give you more comfort that you have a level of control over things, in addition to just being generally good for your health and outlook.

Talking at you and not explaining things is nothing like the standard of care & in your position I'd really push for them to do a better job. They should be giving you a detailed explanation of the disease, what your situation is, why they are stenting, and what kind of risk factor modifications you should be lstriving for, and they should be giving you time and space to consider and ask questions. They should definitely be giving you advice about exercise, ideally referring to you a structured exercise program if available in your area.

But unfortunately inadequate care for PAD seems to be a general problem in lots of places, including here in Oz. It's seen as less serious than CAD, incorrectly, and not as sexy.

I found that educating myself about the disease was more useful than any advice I was getting from HCP's. You've probably been to the NHS site: https://www.nhs.uk/conditions/peripheral-arterial-disease-pad/treatment/ Being in Oz I get to pick & choose and I actually find that US guidance is usually more thorough and informative. This from the American Heart Association is a good starting reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000470

Best of luck! Let us know how you get on.
Hi Eddy

Thanks so much for your comprehensive response. It does seem that there are massive inconsistencies around the treatment pathways for PAD. With the NHS at the moment, it’s a bit of a production line, ‘in one door, this is what’s wrong with you, this is what we are going to do, you may have to wait over a year, close the door on the way out’ (in fact my Vascular Consultant was still talking at me as he left the room for the next patient).

Encouraging information around the exercise you are taking and your approach. I have stared to do 2000 a day but I have CAD and an Aneurism (right leg) as well, so I really don’t want to do anything to rupture it, so I’m still a bit in the dark over this. I need to go back to Vascular and ask them how big the dam thing is and take it from there.

Will keep this thread posted as my journey progresses.
 
Ah, I've been chatting to a friend of mine who is a GP (He knew I was having leg pains, as he was there on a walking holiday when they started to get bad after walking up hills) and he reckons that high BG causing dehydration leads to fluid imbalance and issues with minerals - which causes leg pains and muscle twitches. Hence why it went away as soon as I got it back down to normal levels.
 
Ah, I've been chatting to a friend of mine who is a GP (He knew I was having leg pains, as he was there on a walking holiday when they started to get bad after walking up hills) and he reckons that high BG causing dehydration leads to fluid imbalance and issues with minerals - which causes leg pains and muscle twitches. Hence why it went away as soon as I got it back down to normal levels.
Hi harbottle, excellent news that you seem to have identifed the cause of your pain. It makes sense.
 
There’s a new screening tool being developed for PAD and hospitals are looking for volunteers to test the equipment, if any of you feel is relevant to you then I am happy to post the link, I took part myself and found it really helpful and also interesting to see the team learning to use the equipment.
 
There’s a new screening tool being developed for PAD and hospitals are looking for volunteers to test the equipment, if any of you feel is relevant to you then I am happy to post the link, I took part myself and found it really helpful and also interesting to see the team learning to use the equipment.
Yes please, if you could send the link, I would be interested in taking a look.
 
The good news is that the aneurysm in my right leg is only 1.6cm as measured in June last year. The blockage in my right leg is a Short Occultation at the top of the Artery and my Cardio blockage is less than 70%. So I can exercise again (as long as I don’t raise my BP too quickly). Lets get some new blood vessels growing
 
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The good news is that the aneurysm in my right leg is only 1.6cm as measured in June last year. The blockage in my right leg is a Short Occultation at the top of the Artery and my Cardio blockage is less than 70%. So I can exercise again (as long as I don’t raise my BP too quickly). Lets get some new blood vessels growing
Please take care Terry
 
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