Published December 1, 2005 in issue 0448 of the Hook

BY JOHN HONG, MD

There are too many homonyms and acronyms that all sound the same but have different meanings. How in the world can we keep up with all the different meanings for the same-sounding words?

For example, PSA in medicine means "prostate specific antigen," but at the news station it means "public service announcement." There are many meanings for "Pad." There is finger pad, knee pad, pad thai, you live in a cool pad, maxi-.... In medicine, PAD stands for "peripheral arterial disease." Is PAD bad news?

About 12 million Americans have PAD, but it remains highly under-diagnosed. Some patients think their leg pain is arthritis and say, "Doc, my calves are killing me. I feel like I've been walking in Jimmy Choo eight-inched spiked heels across the Great Wall of China-- but in reality I've only been shopping for 10 minutes in my tennis shoes. I couldn't even walk over in time to grab the blue-light special. It must be arthritis."

PAD is not arthritis; it is atherosclerosis, which means the arteries are clogged with cholesterol like Hell's Kitchen sinks are clogged with grease and fat trimmings. As the arteries start to narrow because of cholesterol plaques, blood flow to the extremities slows-- particularly to the legs. What is farthest from the heart? The feet and calves (as well as insurance companies and Pat Robertson).

When a person with PAD walks, and the calf muscles need more blood for oxygen, nutrition, and removal of bi-products, the calves start to hurt (that's called "claudication"). Because of the pressure of the blood pushing through the narrow arteries, inflammation occurs along the cholesterol plaques and arterial walls. Platelets accumulate and further narrow the arteries, which leads to more pain. It's like that song from The Wiz, "You Can't Win." Or can you?

The classic symptoms of PAD include calf pain that occurs only with exertion, stops you from walking, and resolves within 10 minutes of rest. So when I hear a patient say, "I think I have PAD because when I sleep my legs cramp," I figure it's something else-- like restless legs syndrome, an electrolyte problem, or simply being out of shape-- but not PAD.

Remember, PAD occurs when the legs are active and need more blood. However, most PAD patients actually are able to walk despite the claudication, and the pain can linger for more than 10 minutes after resting. Other areas of the body like the thighs or arms might hurt instead of the calves, depending on which arteries are clogged.

People with spinal stenosis (narrowing back bones that pinch on the spinal cord) have something called "pseudoclaudication," which means pain in both legs that occurs with standing up straight, walking up hills that makes the lower back arch and is alleviated by bending forward like an old person using a cane.

Smoking is perhaps the biggest cause of PAD. Local hero Sissy Spacek, unfortunately, has earned a Hackademy Award from the American Lung Association for her frequent on-screen puffing (but a relative says the Academy Award-winner is not a smoker in real life).

Smokers aren't alone: diabetics, people with high blood pressure and cholesterol, and those who have already had a stroke or heart attack are also at high risk for PAD. People with PAD probably have clogged arteries elsewhere, so they tend to have higher mortality and morbidity rates than those without PAD.

Diagnosis is pretty easy: an ABI procedure (ankle-brachial index) that involves taking blood pressure in the arms and legs with an ultrasound device. Treatment involves not smoking, lowering cholesterol, exercise to develop more circulation, and anti-platelet medications like aspirin and Plavix. So if you have symptoms of PAD, see your MD PDQ ASAP 2B OK.

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