…my cuppa iced coffee…

After outlining the risk factors and the stages of the window-shopping disease in Part 1 and Part 2, the final part of the article by Professor Roswitha Wolfram describes the treatments that are currently available.

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Treatment of PAOD

There are multiple approaches to treat circulatory disorders of the legs according to the various stages of the disease: Functional training (gait training), medication, invasive approach by utilizing catheters and stent grafts, and occasionally, a bypass operation may be necessary.

1. Gait training: Many small steps in the right direction

In early stage of PAOD, gait training and specific physical exercise are fundamental. The training is aimed to reduce the symptoms and improve the walking capacity of the patient. Your doctor will decide whether this form of treatment is suitable for you as in later stages of disease, especially when rest pain occurs or tissue is damaged, training is no longer an option. Regular exercise stimulates the growth of new blood vessels (angiogenesis) which can act as natural small bypasses for the blocked artery and will allow supplying the muscle with the oxygen he needs. Pain is reduced and the pain free walking capacity increased substantially.

Walking distance, speed and duration of walking during gait training need to be tailored to the individual needs and capabilities of the patient, gait training is not supposed to cause too much pain otherwise the patient will be discouraged. Training in intervals has proven very efficient in this context: during exercise you stop briefly just before the pain kicks in, you rest a little bit and continue with the training, another break and continue afterwards. This form of training should be performed during a 1-2 hourly walk on a daily basis. You will see that it will get easier every day with fewer necessary stops.

Other activities that have been proven to be beneficial are cycling, walking up stairs and standing on the tip of your toes. During the latter mentioned exercise you repeatedly stand on the tip of your toes until again the pain kicks in then you rest a little, and then start again and so on. For all the exercises, the most important message is to do to them regularly, multiple days a week (preferably daily), it is not necessary to do strenuous exercise and power yourself out.

2. Medication

For the treatment of PAOD, there is some pharmacotherapy available. The cornerstone are the so-called platelet function inhibitors, among them are aspirin (the same aspirin the doctor prescribes when you have a heart condition, for example) and Colopidogrel (Plavix is the brand name). The aim of this therapy is to prevent or, at least, delay progression of disease. In addition, there are some so called vaso-active substances available which are able to improve the blood flow. These medications are prescription only and will require a previous thorough examination of your vessels by your treating physician.

3. Non-surgical and surgical procedures

Balloon dilatation is a standard procedure for the treatment of PAOD. During this intervention a catheter is inserted into the artery and advanced through the narrowed part of the vessel. After that, a balloon is inflated to re-open the segment that is either narrowed or occluded. With this technique it is possible to dilate the artery and re-install proper blood flow. Sometimes it is necessary to put an additional stent (supportive corset for your vessel) which will help the artery to stay open after successful balloon dilatation.

Surgery is usually only performed if the disease is in a very advanced stage and there is a severe risk to loose a limb. Which technique will be applied in the individual case depends on various factors: stage of disease and exact location of the involved arteries. In some cases a bypass surgery will be beneficial. During this procedure, the occluded part of the artery is bypassed and blood flow re-installed. How successful these procedures will be in the long run mostly depends on the patient and how consequently he takes care to minimize his risk factors, as progression of anthrosclerosis can only be prevented by tight control of its underlying causes.

Taking good care of your legs and feet

Impaired blood flow in your limbs in the context of PAOD also implicates that even the smallest injury will not heal properly and can lead to tough infections. To prevent such complications, you should take special care of your legs and feet and avoid injuries. Furthermore, you should avoid wearing tight shoes and stockings. While sitting you should not cross your legs. If you are diabetic, you should be especially careful as diabetes can cause a loss in sensitivity which may result in a tendency to get injured much easier but also to detect it much later.

A daily self-inspection of your feet is therefore very important. Please consult your physician immediately if you discover new injuries, your conditions deterioriate or if you develop new symptoms. Do not try to cure yourself alone. Only your doctor will be able to identify your problem properly and advise you on the best treatment option.

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Images from:

1. Faculty of Rehabilitation Medicine, University of Alberta
2. Pharmaceutical-Technology.com
3. Calgary Foot Clinic
4. Detox Secret

Related posts:

• The Window-Shopping Disease – Part 1
• The Window-Shopping Disease – Part 2