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Why leg pain should not be ignored

May 23, 2014

Leg pains while exercising often are dismissed as an unpleasant but not serious side effect of exercise, particularly if the pains subside with rest. However, these leg pains should not be ignored as they may be a warning sign of peripheral vascular disease (PVD), a serious condition that often initially manifests itself in pain in the calf region during exercise.

PVD is a disease of the arteries that affects the blood vessels outside the heart, impairing peripheral circulation. While it may begin with cramping in the arms or legs, it often is an indicator of risks from a very serious disease existing in other parts of the body, such as the heart, abdomen and brain, according to Washington Hospital cardiologist Ash Jain, M.D., and Washington Hospital vascular surgeon John Thomas Mehigan, M.D.

"When these factors begin affecting the heart, abdomen and brain, patients then have an increased rate of mortality," Dr. Mehigan says. "It's not the leg pain that kills them, but the underlying heart and brain conditions, including heart attack and stroke, that will prove deadly."

PVD can lead to aneurysms in the abdomen, heart and brain and can cause blockages in the carotid arteries in the neck and in other areas resulting in heart attacks, strokes, or other life-threatening incidents. In the abdomen, PVD leads to a weakening of the arterial wall that can result in rupture and death, Dr. Jain said.

"Diagnosis of an aneurysm in the abdomen can be difficult and treatment is somewhat different that those affecting the heart and brain," he added. "This is why it is so important to be aware of PVD and see a doctor when you first feel pains in your legs, arms or abdomen."

On Tuesday, June 3, from 1 to 3 p.m., Dr. Jain and Dr. Mehigan will hold a free public seminar on peripheral vascular disease in the Conrad E. Anderson, MD, Auditorium, Washington West, 2500 Mowry Avenue, Fremont. The seminar is open to all interested individuals but seating is limited to the first 63 persons to sign up.

Additionally, the two doctors will run a free PVD leg screening from 10:00 a.m. to 1 p.m. on June 7, in the Conrad E. Anderson, M.D located in Washington West, 2500 Mowry Avenue, Fremont. Individuals interested in the leg screening must sign up in advance by calling (800) 963-7070. Leg screening participants will have to meet pre-determine diagnostic criteria and the number of participants will be limited.

At the seminar, Dr. Jain and Dr. Mehigan will give a general overview of PVD, including the areas of the body most affected by PVD. They will explain risk factors and the latest treatments including the newest minimally invasive surgical treatments.

"These new surgical approaches, generally angioplasty on the affected arteries, are much less invasive and allow the patient to return home as soon as possible," Dr. Jain explained. "Early detection and treatment allows the patient to avoid major surgery and have better results."

The goal of the seminar and screening is to raise awareness so individuals will talk with their doctors before experiencing a heart attack or stroke that perhaps could have been prevented.

"We want audience members to learn the signs of PVD so they can seek help in the early stages of the disease which will make management of the disease easier and will lead to better overall results," Dr. Jain said.

If PVD is not addressed, it quickly can become a vicious cycle of worsening risk factors that can lead to heart attack, stroke and even a loss of limbs, Dr. Jain added. Patients often become increasingly sedentary, increasing their chances of developing diabetes, high cholesterol, hypertension and obesity.

"You can say, 'It's just my legs that are hurting, and it will not kill me,' but, if left untreated, PVD makes regular exercise intolerable - and it's regular exercise that help prevent blockages from getting worse in all the organ systems," Dr. Jain said.

Risk factors that may indicate PVD - as well as heart disease and stroke - include:
¥ Diabetes
¥ Cigarette smoking
¥ High blood pressure (hypertension)?
¥ High levels of the "bad" cholesterol, low-density lipoprotein (LDL)
¥ Previous stroke or heart attack
¥ Obesity
¥ Sedentary lifestyle (minimal regular exercise)
¥ Age (Men over age 50 are affected more frequently.)
¥ Family history of heart disease
¥ Cardiovascular disease, covering several conditions affecting the heart

According to Dr. Mehigan, the best place to start looking at your risk for PVD, heart attack, and stroke is your family tree.

"Examine your family history for these risk factors," he notes. "If you don't know your history, find out about it. What did your mother die of? What did your father die of? This information can give you important clues about your hereditary risk."

If you have multiple family members that suffered from heart disease, there's a good chance that you could as well. Dr. Mehigan advises talking to your primary care physician and being screened for factors like high cholesterol, high blood sugar, and high blood pressure, all strong risk factors.

The free PVD leg screening on June 7 will use a painless, non-invasive protocol to detect whether or not a person has PVD. After the test, the physicians will explain the results and, if necessary, refer participants to their primary care physician.

In advanced stages, PVD may require more aggressive treatment options such as revascularization with angioplasty or surgery along with diet, exercise and drug treatment, including medicines to help improve walking distance like antiplatelet agents, and cholesterol-lowering agents (statins).

Dr. Mehigan added that the first steps toward improved cardiovascular health are healthy diet and regular exercise. "The sooner you can incorporate these things into your lifestyle, the better your overall health will be."

"PVD can be easily fixed, if diagnosed early on. In advanced stages, it can be tedious to keep the arteries open," according to Dr. Jain. "Hence, the earlier you recognize the symptoms and the earlier the diagnosis is made, easier the treatment is.

"Early diagnosis and managing the disease, rather than procrastination and denial, is the best and easiest way to live a healthier and longer life," Dr. Jain said.

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