Our front office staff was challenged to do the ALS Ice Bucket Challenge. Since we see patients from all walks of life in our practice, we enjoyed the opportunity to help raise awareness and to support the research to find treatments and a cure for ALS. We encourage you to go to www.alsa.org to check out more information and for the opportunity to easily make a donation to help fight against this deadly disease.
“My new shoes fit kind of tight and they rubbed some skin off the top of my big toes. Can you take a look at them?” Normally that question would be no big deal. But when the patient has weak to non-existent pulses in their feet, diabetes, and smokes, it can be a huge deal. That was the case with Mrs. Brown, and a culture of the abrasions showed that they were already infected as well. Her future will almost certainly hold visits to a wound care center, vascular studies and possibly MRI’s to be sure the infection hasn’t spread to the bones.
One of the main underlying problems for her and many others is something called peripheral arterial disease (PAD). PAD is generally a result of atherosclerosis, the build-up of plaque that slowly blocks arteries. The end result of atherosclerosis can be a blocked coronary artery causing a heart attack, a blocked cerebral artery causing a stroke, a blocked artery in the gut causing intestinal problems, or blocked arteries in the limbs causing PAD.
Who gets PAD? Generally the same folks who are at risk for heart attack or stroke may get PAD. So the risk factors would include smoking, diabetes, high blood pressure, high cholesterol, obesity, age over 50, and a positive family history of PAD, heart disease or stroke.
How would you know it if you were getting it? That can sometimes be a little tricky. Only 10% of people with PAD get the classic symptom of intermittent claudication (IC). IC refers to a symptom where people’s legs (usually the calves) predictably begin to cramp after a certain distance of walking. The cramping or muscle pain resolves after 2-5 minutes of rest.
But 90% of the time people with PAD have less obvious symptoms. They have subconsciously limited their walking and have more vague leg pains, a sensation of heaviness in the legs, poor healing of wounds or, in 40% of patients with PAD, no symptoms are reported at all. So the diagnosis can sometimes be difficult. One clue is sometimes the new onset of ED (erectile dysfunction), although the majority of men with ED don’t have significant PAD.
A test called the ankle-brachial index (ABI) is the most common initial test to sort out whether PAD is the problem. More involved tests such as types of vascular MRI’s or cat scans may follow if a substantial problem is found.
If PAD is confirmed, non-surgical treatment is initially tried unless a critical, limb-threatening blockage is already present. Quitting smoking has the biggest impact on preventing PAD from worsening. Beyond that, certain meds and lifestyle changes to manage high cholesterol, high blood pressure, diabetes and obesity can be helpful. There are also a small number of meds that have a modest effect on opening up (dilating) the arteries or reducing the tendency to form unwanted clots. Regular walking up to the point of claudication (muscle pain) is also helpful to maintain and sometimes regain circulation.
PAD is also a red flag for other blockages that can lead to heart attack or stroke so that an overall evaluation for these is wise when PAD is found. This connection explains why the mortality for patients with claudication is approximately 30% at 5 years, 50% at 10 years, and 70% at 15 years.
As is so often the case, prevention is the best approach. But if symptoms of PAD seem to be sneaking up on you, have your physician check you for it and start to battle this threat to life and limb.
“Fed Up” is a documentary that examines the role of sugar in the obesity epidemic. Any documentary should be watched with an open mind to challenge us to think of things in a new light. “Fed Up” was very eye opening in revealing the hidden sugars that are added to items to make them more “palatable”.
There were important references to some dietary goals which were presented in 1977 that concluded low fat diets were “the way to go” http://zerodisease.com/archive/Dietary_Goals_For_The_United_States.pdf. The evidence was not particularly strong, yet dietary recommendations were made accordingly. Removing fat from a product removes the flavor, which typically is replaced with added sugars. Fourty-fifty years later we have obesity and diabetes that have skyrocketed. Certainly there are many factors that contribute to the rise in the obesity and diabetes epidemic but, the added sugars are likely a big factor.
One of the BIG things that I wish the film had mentioned was CARBOHYDRATES. When we consume carbohydrates, they convert to sugar and then causes insulin to be released from the pancreas. Insulin then stores the excess sugar in various places in the body including the liver (as triglycerides) and the abdomen (as fat). So it would be a big fail if I didn’t mention the importance that excess carbohydrates play in contributing to obesity and diabetes (as well as many other unwanted medical conditions).
I gathered that there is a strong push for political overhaul and changes in funding, advertisement and availability of products. There were multiple clips of children in schools who kept choosing burgers and fries over fruits and vegetables. In fact, local schools in east TN are suggesting that the recent legislation which provided schools with funding for healthier options is actually money being wasted because students aren’t choosing healthier options. How about we think of this issue differently and remember that healthy eating habits…..well…..they start at home.
It is important to remember the basic concepts of supply and demand. Because of consumers demand in recent years we have seen options such as: low carb menus (yes, even at Cracker Barrel!), grass fed beef in grocery stores and even in restaurants, more organic options and less preservatives in foods. Likewise, if the demand for a product decreases, its likely as a result of the consumers who aren’t buying it as much. I suppose this is the very fear of the BIG companies who the film suggested that we should “demonize”.
The documentary made brief mention of a family that had cut out all added sugar and starting cooking meals at home for several weeks. As a result, the mother, father and son lost a lot of weight and felt better. This was such an encouragement to see, I only wish more of the film focused on ideas, stories, and suggestions to encourage families to make these changes at a personal level….within the four walls of their own home. With that said….I’ve got some work to do in my own kitchen. Happy healthy eating to all!
“Let food be thy medicine and medicine be thy food” -Hippocrates
A few facts from Fed Up website:
-One sodaa day increases a child’s chance of obesity by 60%.
-There is overwhelming evidence of the link between obesity and the consumption of sweetened beverages, such as soft drinks, energy drinks, sweet teas, and sports drinks
-In 2012, Americans consumed an average of 765 grams of sugar every 5 days, or 130 pounds each year.