What do you know about PAD?

During the year we pay special attention to different diseases.  We try to bring information to the forefront about these illnesses.  One of the conditions that we highlight his month is    Peripheral Vascular Disease or PAD.   This is a particularly insidious condition that robs many people of their freedom and their lives.

Did you know that it is estimated that a leg is amputated every 30 seconds worldwide due to diabetes?  Did you know that 65,000 to 75,000 amputations are performed in the US each year?  Did you know that African Americans are more likely to undergo amputations than Caucasians.  Did you know that 8000,000 people live with PAD in the US today.

PAD happens when the arteries that carry blood to your extremities are blocked.  Those life-giving arteries may become blocked by plaque or cholesterol and the blood is not able to make its way to the extremity.  When this happens to the arms it may result in the loss of an arm or hand or finger.  When this happens to the legs there maybe the loss of a leg or foot or toes.

We see this same mechanism in the brain where we may see a stroke or when the arteries of the heart are involved, we could see a heart attack.  

There are certain medical conditions that seem to invite PAD to the table.  We know that one in three people who are 50 years of age and older who has diabetes will also have PAD.  We know that those that have heart disease, high blood pressure, elevated cholesterol, that are overweight or have chronic kidney disease all are at increased risk for PAD. 

If you smoke or use tobacco products there is a four times greater risk that you will develop PAD.  Those that have little to no physical activity are also at increased risk of PAD.  One of the most important risk factors is if there is a family history of PAD you have an increased risk.  As one ages especially after the age of 60 there is again an increased risk of PAD.

  One of the most shocking facts is that there is an increased risk of PAD in the African American population.  There is two times greater risk of PAD than in the Caucasian population.

 So what are the signs and symptoms one should be looking for?  Leg cramping is one of the symptoms.  If you noticed that one time you could walk four blocks with no difficulty and now you have cramping in your legs with two blocks that is a symptom.

If you notice that at one time you had a lot of hair on your legs and now the amount of hair has decreased or is nonexistent, this is a problem.

If you notice that sores on your extremities are taking a longer time to heal, there may be a problem.  If there are discolorations of the feet such as they are purple in color, there may be a problem.   If there is just pain in those legs and feet while you are just resting or there is numbness, heaviness, or cold feet there maybe a problem.  A fact that just blows things away is that 40% of people who have PAD will have no symptoms.

Because of this fact we all must be proactive in making sure PAD does not affect you.  Make sure you have your healthcare provider to look at your feet and legs.   They may want to do testing to make sure there is adequate blood supply to the area.  They may do doppler or ultrasound studies, take the blood pressure in the legs as a way of accessing the arteries, do labs to check on the cholesterol and renal functions,

There are things you can do to fight PAD.  One is to become and stay active.  If you smoke or use any tobacco products, stop them.  They are extremely damaging to your body. Eat a diet that is heart healthy.  Eat more fruits and veggies, limit your fatty foods and salty foods.  Take good care of your feet.  Get care for those bunions, calluses and fungal infection promptly.  Make sure your shoes fit well. 

PAD is a disease we all must be aware of and fight.  Now go out and get those feet checked. 

Diabetes Is Complicated

To say that diabetes is complicated is an understatement. Diabetes is when the blood sugar is elevated over a prolonged period of time. Initial symptoms may include frequent thirst, increased urination and increased apatite. The problem though lies in the consequences that happen in those with diabetes. These patients if left untreated may unfortunately manifest many health problems. Serious long term complications include heart disease, stroke, kidney disease, foot ulcers, damage to the nerves of the feet, eye disease and loss of cognitive skills or dementia.

Diabetes comes about when the pancreas that makes our insulin, that the body uses to keep our sugars under control, is either not making enough insulin, the quality of the insulin made is defective or the cells of the body are not responding to the insulin that is being made. This results in the sugar numbers being elevated and the complications start to add up.

There are over 30.3 million or 9.4% of Americans are diagnosed with diabetes in America. Add to that the 84.1 million people that are pre diabetic in this country and you can see that we have a huge problem on our hands.

When the body does not make insulin, it is called Type 1 diabetes. The more common diabetes is Type 2. Here we see the cells of the body not respond to the insulin that is being made. As we age though we progressively make less insulin each and every day so we may see a lack of insulin also. This is why we previously would see Type 2 diabetes in people as they got older. The significant increase in obesity, especially in the young, means we are seeing a huge increases of diabetes in younger people. Obesity increases the occurrence of diabetes as does inactivity. Diabetes at least doubles a person’s risk of early death.

As we see more and more people develop diabetes the medical profession has finally said we need to be more aggressive. Recent thoughts have led to the adoption of treating the patient earlier in the course. The pre diabetic is where the treatment should begin. Not allowing the patient to have years of elevated glucose readings and then starting treatment.

When we speak about diabetes many patients would be afraid that they would be starting on insulin. We are at a space in time where we are fortunate to have

several great medications that are quite effective in correcting the defects that diabetes causes in the body, and they are oral for the most part.

Many people like to hide behind the prediabetes term and chose to not be aggressive with the treatment of this possibly devastating disease. We see diabetes in families. If you have family members with diabetes, be proactive and get yourself tested for diabetes. If you were diabetic during pregnancy, you have an outsized chance of becoming diabetic. Be proactive and keep a check on your status with diabetes.

Obesity is one of the fore runners of many diabetic patients. If you are obese keep a solid eye on your diabetic status. If you are obese, try to lose weight and become more active. Remember your enemies include bread, pasta, potatoes, rice and sweets. Limit your consumption of these. Develop a sustainable exercise program. Learn about your diet. Let your healthcare provider know you are aware of the consequences of not treating diabetes and you prescribe to the new way of thinking. Let them know you do not want to wait until you develop diabetes, but you are proactive and want to prevent yourself from becoming diabetic.

Diabetics do not die of diabetes they die of heart disease. Diabetics have a four times greater risk of developing dementia. Does it have to be that way? No, be proactive.

Who Said Life Would Be A Rose Garden

If we have learned one thing over the last two years, it is that life is not always going to be a rose garden. In fact, we have all had very few rose gardens during the last two years, or did we?

Dealing with the stresses of life has been a growing episode for most. Most people are not born with the skills to deal with stress but rather it is a skill that we hone into as we deal with life. Experts believe that parents have the initial job of helping their children deal with stress. Certainly how they handle stress is one of those ways and how they help their children handle stress with guidance is a major way of developing those skills.

Handling stress involves being resilient to life’s ups and downs. It involves realizing that there are different ways to skin a cat and finding the way that is best for the situation you may be in.

It is important that people use the resources at hand. So many situations may require collaborative skills. Use the strength of your family, friends, community, and culture to help. Make sure your tribe is inclusive of positive and encouraging people. People who will be honest as they help you deal with the situation. This aides in the ability to look at a problem from different angles. Angles that if looked at solo would not have been seen.

One of the most important ways to deal with the stresses of life are to make taking care of your physical health a priority. It is so important to take the time to eat nutritious foods. It is important to limit or cut out junk food and invest in the fuel used in your body.

Being physically active also helps with dealing with the stresses of life. Moving that body, helping it to become strong and efficient are such a plus. It cannot be emphasized the importance that sleep brings to being able to be clear-minded and having the energy to deal with the stresses of life.

One of the most important habits in being successful in dealing with stress is to take time for yourself. So many that are stressed are so busy taking care of others that they forget to take the time to take care of themselves. Taking care of oneself could mean watching a movie you enjoy or cooking a meal you adore or just not doing anything. Selfcare is defined by your wants and likes but it must be something that you enjoy. Some experts make a simple suggestion of

taking no less than five minutes each and every day and doing something that brings joy into your world.

Dealing with the stresses of life also includes having a guide that you live your life by. Having principles that give your life structure and meaning are indeed helpful in dealing with stress.

Looking at the stressful situation and finding what it has to teach you is another strategy of dealing with stress. What can you learn from this situation? How can you turn these lemons into lemonade?

Being honest with yourself and seeking help with a trained therapist is another way to deal with the stresses of life. Here you get help in dealing with the stress. You get to develop strategies that become tools in your toolbox of life.

Life is to be lived and enjoyed. Stress is a part of any life. It is how you deal with the stress that is the difference. Be proactive and deal with the stress in your life in a positive way.

To Take Or Not To Take

Just like anything else in life, sometimes a fresh look at an old subject is in line. When we look at things we have always done with the advantage of new data or information, new and improved changes may occur.

So, forever and a day so many people have been taking baby aspirin for the primary prevention of cardiovascular disease. Countless baby aspirin has been consumed in the name of living longer and in good health. Well, a fresh look at this with the added advantage of new data has recently occurred, and guess what? New data drives new recommendations.

Now, if you have a history of heart disease heart or have a very strong family history of heart disease, hold on. If you have that type of history, be sure to take an assessment to quantify what your risk are. The fact is that it would not be a bad idea for all to take a risk assessment. There are a host of assessments you can take. An example is the ACC/AHA Cardiovascular Risk Calculator. You can find it online and answer the questions to get an idea of your cardiovascular risk. Here people with a greater than 10% ten-year cardiovascular risk are of concern. This evaluation is just a starting place. Of course, you should review this with your health care provider and together see if you are at increased risk for cardiovascular problems and what are the proper steps should be taken.

The new deep dive into the question of if you should or should not be taking low dose aspirin looks at if taking the aspirin is beneficial to you or not.

New data has shown that taking that aspirin daily can increase the chances of possible gastrointestinal bleeding in some people, and intracranial bleeding in others. Either of these events can cause harm and even death. These are the questions that must be answered as to if taking the aspirin is a net loss or net gain for you.

We know with greater age there is a greater possibility of bleeding with taking the aspirin. Remember we stop prescribing most arthritis medications at age 70. Aspirin and arthritis medications are close cousins.

The bottom line is that gone are the days of just taking a baby aspirin as a way of taking better care of yourself. You could be harming yourself. Talk to your health care provider and see what is best for you.

Dr. Veita Bland, M.D. is a board-certified family medicine physician.  She is the host of “It’s A Matter Of Your Health” radio show and podcast.  Go to www.drblandradio.com to listen to past episodes of the show.  

Be Proactive

ISo, the CDC has been more than busy.  They have relaxed some of the mask-wearing recommendations.  Their recommendations, though based on the science that we are seeing a decrease in the numbers of infections and the vaccination rates have been jogging to the psyche.  Are you comfortable with these recommendations?  Are you ready to give up your mask?  Do you trust your fellow citizen to be honest and to continue to wear a mask if they have not been vaccinated?

In an unscientific poll, most people do not trust that people who have not been vaccinated will be honest and continue to wear their mask.  Those not vaccinated are at the most risk of acquiring COVID-19.  Those vaccinated have a much less chance of infection and certainly a much less chance of death but they continue to wear their mask.

After over a year of being told to wear the mask, many feel vulnerable without them.  They display masks with less hesitancy.  A very understandable phenomenon.  Getting back to normal when unable to trust that those around you are not following the rules will have its difficulty for some.

This pandemic has resulted in an increased mental health care need.  In a recent survey, 48% of respondents noted an increase in stress. 

61% of respondents noted an undesired change in their weight (weight gain).

67% noted a change in their sleep habits with 35% saying they slept more while 31% said they slept less.

23% of respondents said their alcohol consumption increased to cope with the stress.

47% in the survey said they delayed or canceled health care appointments due to the pandemic.

You will still be required to wear your mask when entering healthcare facilities.  What I hope will happen though is less hesitancy for people to access their healthcare needs.  There have been reports of delayed diagnosis of cancers which have resulted in missed opportunities for longevity.

Be proactive and schedule your mammograms at least 6 weeks after obtaining your COVID-19 vaccines.  These can be done safely.

Be proactive and make sure you have secured your colon health by getting your colonoscopy or other studies that are appropriate for you.  These are studies that can be done safely even in this area of COVID-19

Be proactive and make sure you are continuing your health care for your chronic diseases.   How is your heart doing?  How are your lungs doing?  Are those kidneys functioning well?  What is the state of your diabetes, is it well controlled?  Hypertension is known as the silent killer because many do not realize they have it.  Hypertension does not take a vacation.  Do you know what your numbers are?  Do you need to see a therapist to deal with the stress of your life?   Have relationships frayed with too much together time?  A good therapist maybe able to help.

We will return to our “normal” life one day and hopefully sooner than later.  Be proactive with your health so you come out on the other side of this pandemic in better physical and mental health than you did when we were thrust into it.

Covid And Accidents

As I was paying my car insurance, I noticed that my carrier said I had received an auto rate reduction of up to 10% because they expected fewer accidents as more customers were driving less during this pandemic.  Now I certainly did appreciate that decrease in my rate but I wondered if there were really fewer accidents since most of us were driving less. 

To my surprise the North Carolina Health News has investigated this exact scenario.  In a recent article written by Greg Barnes they did indeed confirm that we have been driving less but to my surprise that is not what happened to the number of people dying.  

It was noted at one point with the Governor’s Stay-At-Home orders which ran from March 30th thru May 22, the traffic on the roads was down by 40%.  Remarkably overall, we drove 19% less than we did in the year 2019.

What was shocking though was that the number of deaths from car crashes in 2019 was 1,479.  Looking at that period in 2020 the numbers increased to 1,622.  That represented a 9.7% increase in the numbers of deaths and that equated to 114 additional lost lives.

So how did this happen?  We drive less but we die more.  Regrettably, this just did not happen in this state but was found to be a statistic found throughout the country.

A study done by the UNC Highway Safety Research Center seems to have some ideas as to what may have happened.

They noted that there was a decline in the usage of front seat belt wearing from 90% in 2019 to 85% in 2020.  They noted that there was a sense of “emotional distraction”.  They also noted an increase in “risk-taking behavior”. 

They made a point in noting that there is a marked difference between distracted driving and emotionally distracted driving.  Distracted driving usually refers to scenarios such as using a cell phone while driving or fumbling with the radio dials when you should be looking at the road.

 Emotionally distracted driving involved people worrying about their families.  They were worried about jobs, their future, their health and not paying attention to driving because their concentration was elsewhere.

They also noted that the speed of the crashes was higher.  With less congestion of the roads people engaged in higher speeds and we all know that speed is a killer.  It is known that just an increase of 5 to 10 MPH greatly increases the likely hood of injury or death. 

One ray of good news was that the older drivers did get the memo and followed it.  Those 65 years of age and older were involved in fewer crashes.  They seemed to be staying home and thus driving less. 

It remains to be seen what will happen this year.  Hopefully, people will drive more carefully and with better concentration on the roads.  Hopefully, they will worry less about their families and their health and their lives.  That though will only happen if we get our lives back and the economy starts to recover.  Getting the COVID-19 vaccine will help with that with continued proper usage of mask, distancing and staying home off the roads.

Long Haulers

I think I can just see a little light around the bend of this COVID-19 pandemic.  The fear that many healthcare professionals have is that as more people receive their vaccines the public does not become too confident and stop adhering to the basic rules of public health that have helped us get here.

There is not a person alive that does not want to go out and enjoy life as we once knew it but we must continue to adhere to the teachings of Dr. Fauci and other experts.  

Face coverings are here for a while longer.  Remember that gaiters and vented masks are truly considered obsolete because of their compromised ability to protect you.

One of the most confounding problems we are seeing with this pandemic is the fate of the “Long Haulers”.  These are the people who are still suffering from the sequela conditions of COVIF-19.   These souls present with a huge array of signs and symptoms from COVID-19 that keeps growing and growing. Studies are showing that 35% or more of people with COVID-19 will be affected.

The affects are not just the typical respiratory symptoms one would expect but they include just about every system in the body imaginable.  Such symptoms include pain, dry eyes, rashes, muscle weakness, hearing loss, confusion, or brain fog. Others have shown sharp pains in the chest, thyroid problems, seizures, strokes, blood clots, ringing in the ears, and depression. The list, unfortunately, goes on and on affecting more than one organ system at a time.

These symptoms have lasted more than six months in many and unfortunately in some, the damage will be permanent.  Meaning that these problems will be with them for the rest of their lives.  Yet medical science does not have a therapeutic intervention for many of these “Long Haulers”. 

With the advent of mutations, we need to be acutely aware of how destructive COVID-19 has been.   What these mutations will bring to the table is not totally known. We have seen versions that are more easily infecting, and increased virulence.  What will be next no one really knows.

That is why complacency and a cavalier attitude have no place here. We see states softening their mandates of wearing a mask.  The fear is that we will see a resurgence of the virus. 

Stay the course. Wear an effective mask. Continue to practice safe distancing and use proper handwashing and hygiene.  Over 500,020 souls have been lost.  Countless more will be affected with the Long Haulers’ syndrome.  The sequel for this world is unknown but will surely be long and arduous.