Deadly but unknown: peripheral artery disease

Some doctors call it the most common disease that nobody has ever heard of, affecting as many as 12 million Americans. It's peripheral artery disease or PAD for short. While about one in 20 people over 50 have PAD, it can strike younger adults as well.

41-year-old Joe Flood loves nothing more than playing a quick pick-up game of soccer with his kids. Unfortunately, "When they get older and they run continuously, I will have a hard time keeping up with them,” says Flood.

He has peripheral artery disease, a buildup of plaque in the arteries in his legs that causes a decrease in blood flow. When Flood was in his mid twenties, his legs and feet started to suddenly cramp or go numb.

"All of these symptoms would come as I would try to run, jog, and do anything that would put a lot of extra effort into my legs,” explains Flood.

Dr. Emile Mohler, director of vascular medicine at the University of Pennsylvania Health System, says younger patients can make the deadly mistake of ignoring signs of PAD, like leg pain, because they think they've just pulled a muscle.

"Whenever you have cholesterol building in the leg, you tend to have it in the carotid artery in the neck, so you are at much higher risk for heart attack and stroke,” says Dr. Mohler.

Without adequate blood flow, tissue in the legs and feet can die and develop into gangrene. Researchers believe smoking spurs chronic inflammation in blood vessels leading to PAD. Female smokers are 17 times more likely than non-smokers to develop the condition.

While PAD affects males and females equally, African Americans are twice as likely to develop it. Their increased risk makes them as vulnerable as someone who has smoked a pack of cigarettes a day for twenty years. The most effective treatment is to quit smoking and exercising to improve blood flow.

Exercise is what's helped Flood. He says, "My body sort of fixed itself by being in shape."

Now with regular checkups, PAD won't keep Flood on the sidelines. While lifestyle changes like diet and exercise often help improve symptoms of those with PAD, doctors can also prescribe medication for cholesterol and blood clots or perform surgery for blockages.

RESEARCH SUMMARY

KIDS WITH INTESTINAL FAILURE: When a child's intestines can't absorb enough water and nutrients from food to provide for growth and development children experience intestinal failure. Normally, the small intestine absorbs most of the nutrients and water in the foods we eat. Sometimes the small intestine doesn't work properly due to injury or disease or because part has been removed to treat another problem, such as gastroschisis. In these cases, a child may not have enough functioning small intestine to absorb the nutrition they need. SOURCE: (www.seattlechildrens.org)

GASTROSCHISIS: Gastroschisis is a birth defect in which an infant's intestines stick out of the body through one side of the umbilical cord - it is a type of hernia. Babies with this condition have a hole in the abdominal wall. The child's intestines usually stick out (protrude) through the hole. Surgery is needed to correct this birth defect. A surgeon will put the bowel back into the abdomen, if the surgery is successful, over time, the herniated intestine falls back into the abdominal cavity, and the defect can be closed. SOURCE: (www.ncbi.nlm.nih.gov/)

SHORT BOWEL SYNDROME (SBS): SBS is the most common form of intestinal failure. Children with SBS have had at least half of their small intestine removed to treat a disease, injury or problems with the intestine that is present at birth (congenital). For example, the small intestine might be abnormally short at birth, a section of the bowel might be missing, or the bowel does not form completely before birth (intestinal atresia). SOURCE: (www.seattlechildrens.org); (www.my.clevelandclinic.org)

SYMPTOMS: Symptoms of SBS vary, they may include: Diarrhea, bloating, having excessive gas and/or foul-smelling stool, poor appetite, weight loss or inability to gain weight, fatigue, and vomiting. SOURCE: (www.my.clevelandclinic.org)

TREATMENT: A variety of treatments are used to relieve symptoms of SBS. The child's diet may be changed in order to absorb nutrients correctly. Other treatments may include an intestinal transplantation, in which a new small intestine is transplanted into the patient. This may be considered for patients who have frequent, severe bouts of diarrhea or other more serious complications of short bowel syndrome. The child may also take various medications to slow down the normal movement of the intestine (lengthens the time nutrients spend in the small intestine) or they may need total parenteral nutrition (TPN). SOURCE: (www.ncbi.nlm.nih.gov/); (www.my.clevelandclinic.org)

TOTAL PARENTERAL NUTRITION (TPN): TPN is used for children who cannot eat their food by mouth. It is a method of providing nourishment while bypassing the digestive system. TPN solution contains a mixture of fluids and nutrients, such as protein, fats, sugars, and essential vitamins and minerals. The solutions are given intravenously (through a large vein into which a catheter, a flexible plastic tube, has been inserted.). TPN is given over 10 to 12 hours or sometimes longer; infants and children usually receive this type of solution while sleeping. Some children must remain on TPN indefinitely. Serious complications can occur when this form of nutrition is used over the long term, such as infection at the site where the catheter is inserted, formation of blood clots, and liver damage. Despite the risk of complications, TPN can be lifesaving in children and adults unable to take in appropriate nutrition through their gastrointestinal tract. SOURCE: (www.my.clevelandclinic.org)

BREAKTHROUGH STUDY: Children who have complex digestive conditions that do not allow them to eat by mouth may be good candidates for a new treatment called Intestinal rehabilitation (IR). IR is the process of restoring intestinal function through diet, medication and non-transplant surgical therapies. Some children can be weaned off TPN with IR. The goal of IR is to eliminate TPN and prevent the need for intestine transplant whenever possible. SOURCE: (www.seattlechildrens.org)


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