Bully Pulpit: Prevention Options

By | 2017-01-13T20:43:26+00:00 June 1st, 2012|
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Tim GilmerLast month I wrote about a sudden infection in my lower leg that gave me quite a scare. My purpose in sharing that was to motivate readers with ongoing pressure sore problems to do everything they can to heal them quickly and completely — because you never know when an infection can strike, get out of hand and threaten your life.

Most of us are familiar with pressure sores. Many of us have been dealing with problem areas on our feet for years. We get so used to staring at these hard-to-heal wounds that we fail to see the possibility of an underlying cause: peripheral artery disease.

PAD is to our legs what coronary artery disease, or CAD, is to our hearts.  Both tell us we have narrowing or blockages in arteries due to plaque build-up on arterial walls. Those of us with SCI are more likely to acquire CAD — as we age — with greater frequency than the nondisabled population. The same is true of PAD. But since most of us have no sensation in our legs, we can’t feel it. Nondisabled people with PAD feel pain because of it; our biggest tipoff is a pressure sore that won’t heal or that returns again and again. PAD causes diminished blood flow that makes healing very difficult.

We take CAD seriously because it is a common killer. With PAD, since there is no pain, no sickness, just the ongoing routine of changing dressings, we tend to accept it unwittingly. We don’t even know it is there. It develops slowly, over decades, silently, invisibly.

PAD is a very dangerous complication that gets little attention from most primary care physicians. Serious lower extremity infections that can culminate in amputation or even death are more likely if you have PAD.

Fortunately, you have options in dealing with PAD, but only if you aggressively pursue them. If you have a non-healing or very slow-healing pressure sore on your lower leg or foot, tell your doctor you want to have a test that measures your ankle-brachial index, or ABI. This is a non-invasive examination that utilizes a Doppler and compares blood pressure readings from your arms with readings taken at various places on your legs and feet. The results will tell you if you have PAD, and where the disease is, in a general way. A follow-up angiogram, if necessary, will pinpoint the problem.

PAD is treated much the same as CAD — with balloon angioplasty, stenting, and arterial grafting. No matter the option, the aim is the same: re-introduce healthy blood flow.

What about prevention? The typical American lifestyle fuels a “plaque factory” in our bodies — foods high in fats and cholesterol; high triglycerides from lack of activity. Reverse it! Eat lean, balanced, smart — and find a way to exercise. Try functional electric stimulation. Quads, paras — anyone with paralysis — can benefit from FES.

Bottom line: you have options to prevent PAD. Take it from me — do it sooner rather than later.