Tips for Caretakers of Loved Ones with PAD
Peripheral Artery Disease (PAD) occurs when blood flow to the extremities—in most cases legs and feet—becomes blocked due to the buildup of plaque in the arteries. In this interview, Dr. Rundback discusses tips for caretakers of loved ones with peripheral artery disease.
How Serious is PAD?
Peripheral arterial disease affects up to 20% of Americans over the age of 70. It involves blockage in the arteries, affecting predominantly the legs but anything outside of the heart arteries. This can occur in people who have had a blockage in the heart arteries or have had prior strokes and in patients with diabetes, Chronic Kidney Disease, high blood pressure, elevated cholesterol, family history, and smoking.
In many cases, it’s relatively benign. Someone may have a blockage in a leg artery, which is asymptomatic. Those patients just need to be encouraged to have lifestyle changes, make healthy life choices, not smoke, adhere to good diets, and walk or ambulate as much as possible. However, you need to keep a good close eye on these individuals for two reasons. Peripheral arterial disease is a marker of subsequent higher risk of heart attacks and strokes. If somebody has peripheral artery disease, leg pain when walking, wounds that aren’t healing, or pain that wakes them at night, you need to make sure that they are on optimal medical therapy, not so much for the legs but to help prevent heart attacks and strokes.
Secondly, a smaller proportion of these patients may progress to what we call Critical Limb Ischemia (CLI). CLI is a pain that wakes people at night regularly and sometimes patients with CLI have wounds that don’t heal, particularly in people with diabetes, Chronic Kidney Disease, and active smokers. CLI can be extraordinarily dangerous. In the U.S. there is a very high rate, over 100,000, of major amputations a year of lower extremities due to unrecognized peripheral artery disease. Most alarming, half of those patients who have had a major amputation never get a vascular evaluation prior to the major amputation. This needs to be changed. With good care-taking and early recognition, caretakers can make a big difference in preventing amputations.
Does PAD Increase the Risk of a Heart Attack or Stroke?
Peripheral arterial disease is the hardening of the arteries, affecting circulations outside the heart. Patients commonly experience these symptoms in their legs, resulting in pain when walking or pain at night. This pain in their legs or lower extremities may wake them from sleep or even result in ulcers that don’t heal, which can be a problem in and of itself.
More importantly, peripheral artery disease is what we call a coronary equivalent. It is a marker of hardening of the arteries affecting all the arteries in the body, which means that they are at higher risk of heart attacks and strokes, even if they have not had these events previously.
Data suggests that 40% of patients with peripheral artery disease will have a heart attack or a stroke within the next four to five years. This percentage is even higher for patients who have more advanced forms of peripheral artery disease, such as Critical Limb Ischemia. Recognizing the risk factors of peripheral artery disease is important not only in terms of limb loss but also in preventing heart attacks and strokes in your loved ones.
What Are Some Challenges People May Have with PAD?
On average, 20% of individuals over the age of 70 have peripheral artery disease.. Caretakers need to be aware of this and the signs of PAD.
There is a reasonably good chance, particularly if your loved one is diabetic or has chronic kidney disease, high blood pressure, elevated cholesterol, or a history of blockages of the heart arteries, that you may become a caretaker of someone that has PAD. PAD is a hardening of the arteries or atherosclerosis, affecting the circulation predominantly of the legs. What you need to know about these patients is that you need to be very cautious and aware of the development of wounds. If they get a wound that doesn’t heal within a week or two, seems to be getting rapidly worse, or seems to be infected early, they need to very quickly consult a physician and particularly ask for a vascular evaluation.
In general, with these patients, you need to encourage ambulation if they don’t have a wound. The natural tendency, particularly with patients who have a blockage in their arteries, which causes pain when walking, is to be sedentary and sit around. The best form of therapy is active and aggressive exercise. If possible, we urge 30 to 40 minutes of walking a day, three to four times a week. As a caregiver, you want to encourage those type of activities. If patients have leg swelling, you want to make sure they wear appropriate compression and elevate their limbs to reduce the swelling. In all cases, if the conditions are not improving, once again, you need to schedule an appointment with their doctor and encourage a vascular evaluation.
When Should a Loved One Seek Help for Their Non-Healing Wounds?
Minor foot wounds, which can be associated with nail bed care, can be expected throughout your life. These types of wounds typically don’t require any urgent care. However, people with diabetes, patients with chronic kidney disease, elderly patients, and patients with other risk factors – including high blood pressure, high cholesterol, and smoking – need to have a higher measure of caution.
We advise these patients, particularly those in the diabetic population, to see a physician very quickly if they have a wound on their foot that doesn’t heal in a week or two, seems to be worsening quickly, or has a history of a prior wound that didn’t heal well. Specifically, they need to see somebody who can do an assessment of their circulation.
Are There Lifestyle Changes Loved Ones Could Make If They Have PAD?
A really relevant point is that if you are a caretaker of somebody with peripheral artery disease, you have to serve many roles. Still, a key role here is to help that individual undergo lifestyle changes. These lifestyle changes should be positive and beneficial, both in reducing their ongoing risk for cardiovascular events and leg events and improving overall health.
First, if that person is a smoker, you have to make a smoke-free environment. You have to encourage non-smoking. Smoking cessation has to be aggressively pursued. You need to support that in any way possible. Particularly for individuals who might need procedures to fix blockages in leg arteries and elsewhere, smoking almost always results in immediate failure of those procedures – patients can’t smoke.
If they have diabetes, you have to make sure there are healthy diabetic choices such as medication and a good healthy diet. The American Heart Association has guidelines, as does the American Diabetes Association, and you can go on their websites for healthy diet recommendations. You want to treat other risk factors as well. Patients with elevated cholesterol or high blood pressure need to modify their diets and reduce cholesterol intake and make sure that they reduce dietary sodium. These are the types of measures that you need to be aware of if you take care of somebody who has peripheral artery disease. Control those risk factors to reduce the problems that they might have down the line.
Request an Appointment with Dr. Rundback
If you are a caretaker for a loved one with PAD, do not hestitate to request an appointment with Dr. Rundback or one of other vascular specialists at American Endovascular. We look forward to hearing from you!
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