A pain in the leg
It all became painfully clear to Andrew Johnson after he underwent quadruple bypass surgery ten years ago.
As part of his rehabilitation, his doctors recommended regular exercise. As a retired military man, Johnson was no stranger to walking.
But this time it was different. He tried to walk a mile but couldn’t without discomfort. When he approached a hill, the pain became too great, forcing him to stop and rest. “I had to fight through it,” he said. “I had pain in both calf muscles.”
At the age of 68, he knew enough to visit his primary care doctor. He assumed that his doctor would just recommend taking some over-the-counter pain reliever. But the problem was much more complicated. Johnson’s doctor recommended a visit with a vascular surgeon.
Johnson had never heard of peripheral arterial disease or PAD, and now that he has it, he is on a mission to make sure everyone else knows about it.
Johnson readily admits that he didn’t exercise much. And that’s part of the problem with PAD - most sufferers don’t know they have it unless they exercise. “PAD is not debilitating if you’re sedentary,” Johnson said.
The tests for PAD are relatively simple and painless. Initial tests include checking the blood flow in legs and feet to determine whether the pulse is weak or absent; checking for poor wound healing, and comparing blood pressure between arms and legs to determine whether blood pressure is lower in the affected limb.
One of the diagnostic tests is called the ankle-brachial index (ABI). It compares blood pressure in the ankle with blood pressure in the arm to see how well blood is flowing. A normal ABI is 1.0 or greater. The test takes roughly 15 minutes to measure the pressure in both arms and both ankles.
Though the ABI helps doctors learn if PAD is affecting the legs, it will not identify which blood vessels are blocked. That can be determined by several other methods, including the Doppler ultrasound that uses sound waves to tell whether a blood vessel is open or blocked.
Another test is the arteriogram. Considered to be a “road map” of the arteries, the arteriogram can pinpoint the exact location of the blockage in a limb. An x-ray is taken after dye is injected through a needle or catheter into an artery. The pictures from the x-ray can determine the location, type, and extent of the blockage.
Johnson’s test results coupled with his other risk factors — diabetes, high cholesterol, high blood pressure and years of smoking – forced his surgeon to insert a stent to keep open the main artery in his leg.
The procedure has helped but he still has pain in one of his legs. His doctors told him that performing another surgery was just too risky.
To maintain his relative healthiness, Johnson, now 78 years old, has changed his diet and takes his medication with almost religious fervor. His wife, Rosetta, has taken charge of making sure he eats plenty of fresh fruits and vegetables. He still likes his hamburgers though, and every Saturday he has one — but it’s made with lean beef and turkey meat. “Rosetta is a good first sergeant,” he said.
Johnson has also been a good soldier in the fight against PAD. Through his vascular surgeon, Johnson became involved with the Peripheral Arterial Disease Coalition, an alliance of leading health organizations, vascular health professional societies and government agencies dedicated to raising public awareness. He is a spokesperson for the program “Stay in Circulation: Take Steps to Learn About PAD,” co-sponsored by the PAD Coalition and NHLBI.
As part of his work with the National Heart, Lung, and Blood Institute, an arm of the National Institutes of Health, Johnson has served on panels and testified before congressional committees to increase people’s understanding of the disease.
The one bit of advice that he shares is critical. “Anyone who has leg pain and no injury should talk to a vascular surgeon,” he says. “People make the mistake of dismissing the pain as part of old age.”
But that advice is for those who are up and walking around. For those who aren’t, Johnson has another bit of advice.
“As far as I am concerned,” Johnson says, “if you vegetate, you disappear.” |
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Andrew Johnson discovered he had PAD when encouraged to walk after a heart attack. He is now a spokesperson for "Stay in Circulation: Take Steps to Learn About P.A.D," a campaign sponsored by the PAD Coalition and the National Heart, Lung, and Blood Institute. Mark Finkenstaedt Photo
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