Pad – (Peripheral Arterial Disease) – Has Anyone Had An Experience With This?

[Mobi]

It seems that I have PAD, as my symptoms match the condition exactly, and yesterday I saw a specialist at Bumrungrad who has confirmed my self-diagnosis, subject to further tests.

Very briefly, a few weeks ago I started to experience severe pain in my calf muscles and thigh muscles when exercising, which goes away after resting for a few minutes. Sometimes, I also get quite bad pains in my hips or buttocks. At first, I had no idea that my problem was due to the narrowing of my arteries, but once I had read a couple of scholarly articles on the subject, I was left in little doubt that I am suffering from PAD and have been experiencing intermittent ‘Claudication’.

The specialist agreed, but said he wanted to carry out some tests to make sure, as the pains could be caused by a twisted nerve in my spine. This seems pretty unlikely, considering my medical heart history, especially given the fact that I was an extremely heavy smoker for 20 years, before I stopped some 30 years ago, (I was a 4-5 pack a day man ), a very heavy drinker up to 2 years ago and have been an insulin dependent diabetic for more than 25 years.

The specialist, (who was not my regular specialist as she called in sick at the last moment), wanted to carry out a ‘doppler ultra sound exam’, which would have cost more than 12,000 Baht, and if positive, follow up with a CT scan, which would be extremely expensive. He said that if all the results were positive, then I would need angioplasty surgery in the form of balloons or stents to fix the problem.

My scholarly articles state that the first test to confirm the diagnosis is an ankle-brachial index (ABI) test which involves measuring the blood pressure in the arms and ankles doing a calculation to establish the presence of PAD. This test is much cheaper than a Doppler ultrasound examination, but it was never suggested by the specialist.

My article also states that treatment includes medication to help the patient take more exercise, and drugs to reduce the risk of stroke or heart attack, although in my case this is complicated, as I am already on warfarin due to the fact that I have a metal aortic valve in my heart.

It further states that “Surgical procedures may be necessary in cases where intermittent claudication is disabling. The person experiences pain when resting, has open sores that do not heal, or symptoms of gangrene like dying skin in the leg or foot.”

I believe that although my condition may be getting quite severe – as up to few weeks ago , I had no pain symptoms at all, it certainly hasn’t reached the extremes as described above.

It seems to me that the specialist’s suggestion that I will almost certainly need surgery is ‘jumping the gun’ by some distance.

So I am wondering whether if this isn’t yet another case of a hospital going for their expensive tests and treatments, when something less expensive and invasive may be adequate, or will I be taking a big risk if I don’t follow his advice?

So if there is anyone out there who has any experience of this condition and can provide me with information on what tests and treatments they had, I would be very much obliged.

Of course I will be seeking a second opinion before I do anything, but every opinion comes at a price – the first one cost 1,700 baht, just for a very brief examination.

Thanks for any informed replies.

[Lefty]

Mobi,

I have had intermittent in both legs for a number of years (5-7) originally diagnosed via MRI. Able to walk about 200 meters before pain starts and have to stop and rest for a few minutes my mobility scooter is a godsend. Also had ABI TEST which indicate no pulse in ankle area. No pain while stationary. Have been told by my doctors in U.S. that walking longer over period of time will cause blood vessels to grow/expand around blockages.

Given the expensive tests your doctor recommended I would suggest consulting another one. A vascular surgeon can address possible surgery options.

I would be interested in hearing about your case as you progress.

Lefty

[Mobi]

Mobi,

I have had intermittent in both legs for a number of years (5-7) originally diagnosed via MRI. Able to walk about 200 meters before pain starts and have to stop and rest for a few minutes my mobility scooter is a godsend. Also had ABI TEST which indicate no pulse in ankle area. No pain while stationary. Have been told by my doctors in U.S. that walking longer over period of time will cause blood vessels to grow/expand around blockages.

Given the expensive tests your doctor recommended I would suggest consulting another one. A vascular surgeon can address possible surgery options.

I would be interested in hearing about your case as you progress.

Lefty

Thanks for the interesting reply - exactly the kind of experiences I was hoping to hear about.

My pain usually starts after about 5 minutes of walking, although it depends on how fast I walk and anyway it seem it be getting worse. A slow, gentle walk can delay the onset of the pain. But if I try to continue walking or exercising through the pain, it becomes excruciatingly painful and in the end I have to stop. After about 5 minutes or so the pain subsides although I now seem to be getting a lot of intermittent pain when stationary in my right thigh, which is a bit worrying.

I am puzzled why the doc didn't suggest an ABI test, and I confess that I was remiss in not challenging him about it. You know how it is- when you see the doc, your mind becomes a blank.

I have read a lot about lifestyle and exercise as treatment for this disease, and you can even get meds which will relieve the pain to enable you to do more exercise. Surgery seems to be a last resort, as I mentioned in my previous post, but for this doc it seemed to be the first step.

Next week I will try to get a consultation here in Pattaya and see what he says.

I will definitely post updates here.

[Bill Miller]

Yeah, got that.

Similar history. Had  triple bypass in 2011.

That is about the time Social Security docs said "Yeah, between that and neuropathy we judge you are permanently disabled."

I walk as much as I can, but after a short time not only pain, but the leg muscles just wont until I rest.... sometimes just twenty to thirty seconds.

I hear there is a med to help, but on so many already!

I will ask at my next visit to hospital and report if available, and if so if it helps on Hong Kong holiday next month.