Peripheral vascular disease (or PAD)

[Jo_the_boat]

I was referred to a vascular specialist by my (excellent) podiatrist due to some lack of sensation in feet and chilly feet and lower legs. Plus I have muscle pain in calves, buttocks and thighs while exercising, particularly uphill. But since going on new dietary regime walking has improved, and pain has lessened, I suspect largely due to not carting around an extra 20-odd pounds (10 + kilos). I have a physical job, particularly for the past 8 months or so, and cope well with that.

Vascular specialist suspects PVD (or PAD peripheral arterial disease) around the groin area as I'm getting pain from the waist down. He is sending me for further tests to confirm diagnosis before deciding what treatment they can offer. He said that they may perform an angioplasty under local anaesthetic or more intrusively, a bypass.

Now the dilemma – he told me to take aspirin, which is OK, to help thin my blood a little.

Then he told me I was go on a statin to lower (control) my cholesterol, which will be prescribed by my doctor when he receives the report from the specialist. This I am less keen on.

He doesn't think things are too urgent because he wants to see if there is improvement in the next couple of months after aspirin and statin.

He also ordered a full blood screen too which was taken at the time which may throw something else up.

I am on a (very) low carb diet, have been losing weight nicely and my self-administered BG levels seem OK. I'm not due for my first HbA1c test since T2 diagnosis for another month and feel that I want to give the new dietary regime chance to work on everything including cholesterol levels / ratios.

I told the specialist that I had refused a stain on T2 diagnosis but he was pretty insistent that I take one for this unrelated condition. BUT although the cause may be unrelated, the management of it may not be. In other words I think it all revolves around cholesterol, insulin and blood sugar control and the clogging effect they have on arteries

Now I know how some of you feel about statins, I also read that some of you take them, and have done so, for years. Personally I am against taking them but when a specialist recommends them for this newly diagnosed condition I have to try and understand things properly.

I've listened to Ivor Cummins and just read a Zoe Harcombe article on cholesterol (and subsequent q and a). Against their theories is a vascular specialist who looked me in the eye and told me how to proceed (a big lad he was too!).

Sorry this is a ramble and I realize that you can't offer medical advice but not only would I value your input but it may be relevant to others too.

 

[miahara]

I went to see my GP as I was experiencing pain in my legs when walking any distance and was diagnosed with PAD. I waited 7 months for a scan then another 3 months to see a consulatnt who spent about four minutes with me and told me he could operate but there was a chance I could lose a leg. I declined his kind offer!
I've been prescribed Simvastatin and Clopidogrel an anti-clotting drug and have been taking them now for almost two years.
Incidently, it was my initial blood test that identified my diabetes which I've now got pretty well under control though can't really do much about the PAD apart from keeping exercising.

 

[Guzzler]

I understand your dilemma. Having given this some thought I think I would comply and take the statin short term until the root cause of your problem is sorted. I would not be happy about it and would argue the point that while still undiagnosed how could lowering cholesterol be of benefit but that's because I can be an argumentative so and so.
It is fine to have strong views while we are comparatively well but when faced with the big man telling us something is up....

 

[Bluetit1802]

I also understand your dilemma. However, in your shoes I wouldn't take the statins without knowing the full breakdown of my cholesterol. If it happens your cholesterol and lipids are all normal there seems little point in trying to reduce them. If they are higher than normal, then you have a lot of thinking to do. I would wait for the blood test results (and make sure you get a print out!)

 

[Guzzler]

I also understand your dilemma. However, in your shoes I wouldn't take the statins without knowing the full breakdown of my cholesterol. If it happens your cholesterol and lipids are all normal there seems little point in trying to reduce them. If they are higher than normal, then you have a lot of thinking to do. I would wait for the blood test results (and make sure you get a print out!)

As the OP has/is losing weight this may be skewing his figures so I agree, still a lot more consideration needsto be done before making any final decision.

 

[pete254]

Hi Jo,
I was diagnosed diabetic when I went into hospital following a heart attack. I was advised to walk every day (for my heart).
When I started doing this I found that after a few hundred yards I would get acute pains in my calves and feet.
Went for check up and the consultant said yes I had PAD but it was not severe enough to operate.
Bottom line is I carried on walking through the pain for the next couple of years. After 12 months the pain stopped in one leg and six months later the other leg stopped hurting. This was through what they call complementary circulation where the other vessels in the legs increase in size to take the load off the partially blocked arteries.
I did take statins during that period but my feeling is that it was the exercise not the statins (and getting my BG under control) that helped cure the condition.
I can now walk 10 miles or more without any pain.
I hope this helps and good luck with the walking!
Pete

 

[Guzzler]

Hi Jo,
I was diagnosed diabetic when I went into hospital following a heart attack. I was advised to walk every day (for my heart).
When I started doing this I found that after a few hundred yards I would get acute pains in my calves and feet.
Went for check up and the consultant said yes I had PAD but it was not severe enough to operate.
Bottom line is I carried on walking through the pain for the next couple of years. After 12 months the pain stopped in one leg and six months later the other leg stopped hurting. This was through what they call complementary circulation where the other vessels in the legs increase in size to take the load off the partially blocked arteries.
I did take statins during that period but my feeling is that it was the exercise not the statins (and getting my BG under control) that helped cure the condition.
I can now walk 10 miles or more without any pain.
I hope this helps and good luck with the walking!
Pete

What a great outcome, well done.

 

[satindoll]

Its our ever helpful Liver that makes most of the Cholesterol present in our bodies, very little comes from our food,
I used to take statins for years and suffered the side effects, pain in calves, brain fog et al, till I could no longer suffer it.........after my test came back at 3.8 which was ridiculously low my Dr agreed to cut the dosage down from 20mg to 10mg and a lot of the side effects eased, the next test came in at 4 on the dot so I decided to halve the dose again, and the next test came in at 4.5 so I stopped them altogether to see what would happen and low and behold 4.8..........so at some point my Liver had decided to behave itself..........
As a lady of over a certain age, even with Ischemic Heart Disease 3.8 was way too low..........as your body needs cholesterol to work properly, so if I were you I would, if pressed to take them, ask to go on the lowest dose first and if needed work up to a higher dose as they seem to grab a dosage number from thin air and apply it willy nilly.

 

[Jo_the_boat]

Thanks all, some helpful stuff there.
I realize it's not easy answering when there's no clear answer, but thank you.
Well done Pete, that's a great effort from you. And you Miahara, you seem to be managing things well.

I did get an initial print-out and my cholesterol certainly wasn't sky high, 5.2 total, 2 trigs, 1.2 hdl, 3.1 ldl.
If things have improved I'll try and stay off the statins and any conversation with the doc or specialist should be easier.
As I said in my initial post, walking has become more comfortable and I am putting that down to better glucose levels and less weight but I cannot deny there is a problem. It's just how to try and tackle it.

Nils illigitimum carborundum!

 

[Tannith]

What operation is it you guys are referring to to cure PAD?

 

[miahara]

What operation is it you guys are referring to to cure PAD?

As far as I understand (and I'm no expert at all) there are various options depending on the degree of PAD.
1 stretch the arteries with a ballon
2 insert a stent
3 transplant a section of artery from elsewhere in the body

 

[bluejeans98]

I was referred to a vascular specialist by my (excellent) podiatrist due to some lack of sensation in feet and chilly feet and lower legs. Plus I have muscle pain in calves, buttocks and thighs while exercising, particularly uphill. But since going on new dietary regime walking has improved, and pain has lessened, I suspect largely due to not carting around an extra 20-odd pounds (10 + kilos). I have a physical job, particularly for the past 8 months or so, and cope well with that.

Vascular specialist suspects PVD (or PAD peripheral arterial disease) around the groin area as I'm getting pain from the waist down. He is sending me for further tests to confirm diagnosis before deciding what treatment they can offer. He said that they may perform an angioplasty under local anaesthetic or more intrusively, a bypass.

Now the dilemma – he told me to take aspirin, which is OK, to help thin my blood a little.

Then he told me I was go on a statin to lower (control) my cholesterol, which will be prescribed by my doctor when he receives the report from the specialist. This I am less keen on.

He doesn't think things are too urgent because he wants to see if there is improvement in the next couple of months after aspirin and statin.

He also ordered a full blood screen too which was taken at the time which may throw something else up.

I am on a (very) low carb diet, have been losing weight nicely and my self-administered BG levels seem OK. I'm not due for my first HbA1c test since T2 diagnosis for another month and feel that I want to give the new dietary regime chance to work on everything including cholesterol levels / ratios.

I told the specialist that I had refused a stain on T2 diagnosis but he was pretty insistent that I take one for this unrelated condition. BUT although the cause may be unrelated, the management of it may not be. In other words I think it all revolves around cholesterol, insulin and blood sugar control and the clogging effect they have on arteries

Now I know how some of you feel about statins, I also read that some of you take them, and have done so, for years. Personally I am against taking them but when a specialist recommends them for this newly diagnosed condition I have to try and understand things properly.

I've listened to Ivor Cummins and just read a Zoe Harcombe article on cholesterol (and subsequent q and a). Against their theories is a vascular specialist who looked me in the eye and told me how to proceed (a big lad he was too!).

Sorry this is a ramble and I realize that you can't offer medical advice but not only would I value your input but it may be relevant to others too.

Hi, have you tried taking Alpha Lipoic Acid suppliments for your legs. It helps to lower your sugar levels eases peripheral pain. I take it when my legs are really bad. Can be a bit hard to stomach sometimes so don't take on an empty stomach. I've also started taking vitamin B12, Magnesium and D spray. The ALA is 600 MG a day. So take 3 in the morning and 3 in the evening. I take Vitamin D in he Morning and the B12 and Magnesium with my evening Metformin tablet. IF you ever need a chat I'm South Side of Manchester near the Airport.

 

[Jo_the_boat]

Hi, have you tried taking Alpha Lipoic Acid suppliments for your legs. It helps to lower your sugar levels eases peripheral pain. I take it when my legs are really bad. Can be a bit hard to stomach sometimes so don't take on an empty stomach. I've also started taking vitamin B12, Magnesium and D spray. The ALA is 600 MG a day. So take 3 in the morning and 3 in the evening. I take Vitamin D in he Morning and the B12 and Magnesium with my evening Metformin tablet. IF you ever need a chat I'm South Side of Manchester near the Airport.

Hello BJ, thanks for that. Not tried r-ala but am seriously considering it.
To be honest the pain isn't too bad and if I stop for a minute it clears up. But as I said earlier, there is definitely some circulatory problem.
Though I may be making a mistake by not taking anything else (apart from an Aspirin, which makes sense), I am trying to get to the point where my BS are properly stabilized, then see where I am. (no meds, just diet)
This PAD is a new complication and there is far less info on it compared to diabetes which, with the help of folks here, I can hopefully get a handle on.
PAD advice has been, Aspirin and statins immediately - this is where my uncertainty lies.
Not wanting to bore anybody but it looks like the specialist wants to see what effect those two have before a follow-up appointment scheduled for early January.
My dilemma basically is Aspirin and Statin or Aspirin, no statin and very close BS control.
What I need is some proper understanding from Doc and nurse when I go and see them.
What I intend to do is try and present them with some evidence and hope to have an informed, unbiased consultation rather than standard, blinkered advice. I suspect I'll be banging my head against a wall till my HCPs get revised guidelines from the powers that be - how likely is that??
Do you have PAD BJ? Perhaps I'll send you a private message if that's OK?

 

[bluejeans98]

Hello BJ, thanks for that. Not tried r-ala but am seriously considering it.
To be honest the pain isn't too bad and if I stop for a minute it clears up. But as I said earlier, there is definitely some circulatory problem.
Though I may be making a mistake by not taking anything else (apart from an Aspirin, which makes sense), I am trying to get to the point where my BS are properly stabilized, then see where I am. (no meds, just diet)
This PAD is a new complication and there is far less info on it compared to diabetes which, with the help of folks here, I can hopefully get a handle on.
PAD advice has been, Aspirin and statins immediately - this is where my uncertainty lies.
Not wanting to bore anybody but it looks like the specialist wants to see what effect those two have before a follow-up appointment scheduled for early January.
My dilemma basically is Aspirin and Statin or Aspirin, no statin and very close BS control.
What I need is some proper understanding from Doc and nurse when I go and see them.
What I intend to do is try and present them with some evidence and hope to have an informed, unbiased consultation rather than standard, blinkered advice. I suspect I'll be banging my head against a wall till my HCPs get revised guidelines from the powers that be - how likely is that??
Do you have PAD BJ? Perhaps I'll send you a private message if that's OK?

 

[bluejeans98]

Hello BJ, thanks for that. Not tried r-ala but am seriously considering it.
To be honest the pain isn't too bad and if I stop for a minute it clears up. But as I said earlier, there is definitely some circulatory problem.
Though I may be making a mistake by not taking anything else (apart from an Aspirin, which makes sense), I am trying to get to the point where my BS are properly stabilized, then see where I am. (no meds, just diet)
This PAD is a new complication and there is far less info on it compared to diabetes which, with the help of folks here, I can hopefully get a handle on.
PAD advice has been, Aspirin and statins immediately - this is where my uncertainty lies.
Not wanting to bore anybody but it looks like the specialist wants to see what effect those two have before a follow-up appointment scheduled for early January.
My dilemma basically is Aspirin and Statin or Aspirin, no statin and very close BS control.
What I need is some proper understanding from Doc and nurse when I go and see them.
What I intend to do is try and present them with some evidence and hope to have an informed, unbiased consultation rather than standard, blinkered advice. I suspect I'll be banging my head against a wall till my HCPs get revised guidelines from the powers that be - how likely is that??
Do you have PAD BJ? Perhaps I'll send you a private message if that's OK?

I have a leaking heart valve, doctor put me on yet another tablet to slow my heart down. I have the symptoms of neuropathy but pulses in legs are fine. My chiropodist said sometimes the damage is not the nerves in the feet, but muddled up signals in the brain..Please feel free to message me Jo

 

[Bluetit1802]

PAD advice has been, Aspirin and statins immediately - this is where my uncertainty lies.
Not wanting to bore anybody but it looks like the specialist wants to see what effect those two have before a follow-up appointment scheduled for early January.
My dilemma basically is Aspirin and Statin or Aspirin, no statin and very close BS control.
What I need is some proper understanding from Doc and nurse when I go and see them.

The consultant wants to see the effects of statins and aspirin together? How will he know if any improvement is due to either one of them, or both of them together? It would make more sense to me (and I am not a doctor) to try one, then the other. Both together and he will never know which is useful and which isn't.

 

[Struma]

Hello BJ, thanks for that. Not tried r-ala but am seriously considering it.
To be honest the pain isn't too bad and if I stop for a minute it clears up. But as I said earlier, there is definitely some circulatory problem.
Though I may be making a mistake by not taking anything else (apart from an Aspirin, which makes sense), I am trying to get to the point where my BS are properly stabilized, then see where I am. (no meds, just diet)
This PAD is a new complication and there is far less info on it compared to diabetes which, with the help of folks here, I can hopefully get a handle on.
PAD advice has been, Aspirin and statins immediately - this is where my uncertainty lies.
Not wanting to bore anybody but it looks like the specialist wants to see what effect those two have before a follow-up appointment scheduled for early January.
My dilemma basically is Aspirin and Statin or Aspirin, no statin and very close BS control.
What I need is some proper understanding from Doc and nurse when I go and see them.
What I intend to do is try and present them with some evidence and hope to have an informed, unbiased consultation rather than standard, blinkered advice. I suspect I'll be banging my head against a wall till my HCPs get revised guidelines from the powers that be - how likely is that??
Do you have PAD BJ? Perhaps I'll send you a private message if that's OK?

I suspect the two drugs are for different things:
Aspirin is an anti platelet drug. With a narrow lumined, plague filled vessel it is much more likely to block the lumen by clot formation, aspirin helps stop the platelets aggregating.
Statins can actually cause plague regression (even in the heart,) takes a little time though, and also help plague to stabilise and reduce plague fragmentation and subsequent break off and occlusion.
Calf/thigh pain that eases on resting is most characteristic, it's called intermittent claudication.
You may turn up some information by searching for PVD, peripheral vascular disease, as it is still known to many as this.
Good luck on your journey.

 

[Bluetit1802]

Statins can actually cause plague regression (even in the heart,) takes a little time though, and also help plague to stabilise and reduce plague fragmentation and subsequent break off and occlusion.

Are you saying that statins do this in addition to lowering cholesterol? Or are you saying it is the lowering of cholesterol that does it?

 

[Jo_the_boat]

I have a leaking heart valve, doctor put me on yet another tablet to slow my heart down. I have the symptoms of neuropathy but pulses in legs are fine. My chiropodist said sometimes the damage is not the nerves in the feet, but muddled up signals in the brain..Please feel free to message me Jo

Hi BJ
It's my pulses that are weak so it does appear we have a different condition though the symptoms are similar.
As far as I can see though there's no reason why I can't try the supplements you suggest above.
Thanks again

 

[Jo_the_boat]

I suspect the two drugs are for different thin
Aspirin is an anti platelet drug. With a narrow lumined, plague filled vessel it is much more likely to block the lumen by clot formation, aspirin helps stop the platelets aggregating.
Statins can actually cause plague regression (even in the heart,) takes a little time though, and also help plague to stabilise and reduce plague fragmentation and subsequent break off and occlusion.
Calf/thigh pain that eases on resting is most characteristic, it's called intermittent claudication.
You may turn up some information by searching for PVD, peripheral vascular disease, as it is still known to many as this.
Good luck on your journey.

Hi Struma, thanks for that.
It's the first time I've read anywhere that statins can (possibly) reduce plaque.
I think I understand the condition and symptoms and what Aspirin does but don't know whether it's actually the lowering of cholesterol that inhibits / reduces plaque or the direct action of the statins (as Bluetit points out). If it's direct action, of course I'd take them but if it's cholesterol related then there may be different options - BS control or example.
Regarding stabilizing and reducing fragmentation are these directly related to cholesterol control or independent altogether?
I have looked up PVD and the consensus is that statins are the way to go (in addition to aspirin, diet and exercise, which I am doing) - but is that really current thinking or is it becoming outdated according to more recent, but not mainstream / sanctioned, research.
I'm not trying to be difficult or poo poo any ideas, just understand properly before my next docs appointment.
I have found a couple of PAD support groups on line so will be studying them. Whether they are as good as this one I'll let you know!