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PostSubject: Claudication   Claudication EmptyThu Jan 20, 2011 4:36 pm

Claudication
Filed under: Heart & Vascular
Claudication is pain caused by too little blood flow, especially during
exercise. Sometimes called intermittent claudication, this condition
generally affects the blood vessels in the legs, but claudication can
affect the arms too.

At first, you'll probably notice the pain only when you're exercising,
but as claudication worsens, the pain may affect you even when you're at
rest.

Although it's sometimes considered a disease, claudication is
technically a symptom of a disease. Most often, claudication is a
symptom of peripheral artery disease, a potentially serious but
treatable circulation problem.

Fortunately, with treatment, you may be able to maintain an active lifestyle without pain.

©
Symptoms

Claudication symptoms include:

* Pain when exercising. You may feel pain in your feet, calves,
thighs, hips or buttocks depending on where you might have artery
narrowing or damage. Claudication can also occur in your arms.
* Intermittent pain. Your pain may come and go as you do less-strenuous activities.
* Pain when at rest. As your condition progresses, you may feel pain in your legs even when you're sitting or lying down.
* Discolored skin or ulcerations. If your claudication is severe,
your toes or fingers may look bluish or feel cold to the touch. You may
also develop sores on your lower legs, feet, toes, arms or fingers.

Other possible symptoms include:

* An aching or burning feeling
* Weakness
* In men, possibly impotence

When to see a doctor
Talk to your doctor if you have pain in your legs or arms when you
exercise. If left untreated, claudication and peripheral artery disease
can reduce the quality of your life. Claudication may limit your ability
to participate in social and leisure activities, interfere with work,
and make exercise intolerable.

©
Causes

Claudication is often a symptom of peripheral artery disease. In
peripheral artery disease, the arteries that supply blood to your limbs
are damaged. This damage is often the result of atherosclerosis.
Atherosclerosis can develop in any of your arteries, especially those in
your heart. When atherosclerosis affects your arms and legs, it's
called peripheral artery disease.

Atherosclerosis makes arteries hard and narrow. That's because the
arteries get clogged with clumps of fat, cholesterol and other material,
called atherosclerotic plaques. These plaques can make arteries so
narrow that less blood can flow through them. You feel pain because your
leg muscles are not getting enough oxygenated blood.

Claudication isn't the only possible cause of your symptoms. Other
conditions associated with similar symptoms that need to be considered
include spinal stenosis, peripheral neuropathy, musculoskeletal
conditions and deep venous thrombosis.

©
Risk factors

The risk factors for claudication are the same as those for developing atherosclerosis, including:

* Smoking
* Total blood cholesterol over 240 mg/dL (6.2 mmol/L)
* High blood pressure
* Obesity (a body mass index over 30)
* Diabetes
* Age over 70 years
* Age over 50 years if you also smoke or have diabetes
* A family history of atherosclerosis, peripheral artery disease or claudication

©
Complications

In extreme cases, the circulation in your legs or arms can be so limited
that you feel pain even when you aren't exercising, and your legs or
arms might feel cool to the touch. Though rare, severe cases can lead to
poor healing of skin injuries and ulcers. These cuts and ulcers can
develop gangrene and require amputation.

©
Preparing for your appointment

You're likely to start by first seeing your family doctor or a general
practitioner. However, you may then be referred to a doctor who
specializes in disorders of the cardiovascular system (cardiologist) or a
vascular surgeon.

Because appointments can be brief, and there's often a lot of ground to
cover, it's a good idea to arrive well prepared. Here's some information
to help you get ready for your appointment, and what to expect from
your doctor.

What you can do

* Write down any symptoms you're experiencing, including any that
may seem unrelated to the reason for which you scheduled the
appointment.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or
supplements, that you're taking, as well as the dose that you take.
* Ask a family member or friend to come with you, if possible.
Sometimes it can be difficult to remember all of the information
provided to you during an appointment. Someone who accompanies you may
remember something that you missed or forgot.
* Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of
questions can help you make the most of your time together. List your
questions from most important to least important in case time runs out.
For claudication, some basic questions to ask your doctor include:

* What's the most likely cause of my symptoms?
* What kinds of tests do I need?
* Is this condition temporary or long-lasting?
* What treatments are available, and which do you recommend?
* What lifestyle changes can help me?
* If medication is needed, what side effects might I experience?
* I have other health conditions. How can I best manage them together?
* Are there any activity restrictions that I need to follow?
* Is there a generic alternative to the medicine you're prescribing me?
* Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions during your appointment at any time that
you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to
answer them may reserve time to go over any points you want to spend
more time on. Your doctor may ask:

* When did you first begin experiencing symptoms?
* Do you have pain when you're exercising, when you're at rest, or both?
* On a scale of one to 10, how would you rate the pain?
* Does anything seem to improve your symptoms, such as stopping exercise?
* Do you need to sit down to get symptom relief, or does stopping and standing in one place relieve your symptoms?
* What, if anything, appears to worsen your symptoms?

©
Tests and diagnosis

Claudication may go undiagnosed because many people consider the pain an
unwelcome but inevitable consequence of aging. But the tests your
doctor may use to diagnose your condition are often noninvasive and can
get you back on your way to resuming an active life.

Some common tests used to diagnose claudication include:

* Checking the pulses in your feet
* Ankle-brachial index to compare the blood pressure in your ankles to the blood pressure in your arms
* Doppler ultrasound, which monitors blood flow in the area affected
* Magnetic resonance imaging (MRI) or computed tomography (CT) angiography to show damage to blood vessels

The pain in your legs could be due to another condition, such as spine,
joint or muscle problems. Your doctor can make a diagnosis based on your
symptoms and a medical history, physical exam and appropriate tests.

©
Treatments and drugs

Treatment of claudication and peripheral artery disease can help prevent
your disease from getting worse and reduce your symptoms.

If your claudication symptoms don't improve after adopting a healthier
lifestyle, your doctor may suggest other treatment options, including:

* Medications. Your doctor might recommend you take aspirin to
reduce the narrowing of your arteries. He or she might also prescribe
medications that help keep your blood from clotting, such as clopidogrel
(Plavix), dipyridamole (Persantine) and ticlopidine (Ticlid). The
medication cilostazol (Pletal) may help improve blood flow and reduce
your symptoms. Additionally, if necessary, your doctor will also
prescribe a cholesterol-lowering drug (statin) to lower your
cholesterol.
* Angioplasty. Cases of claudication and peripheral artery disease
that are more serious may require angioplasty. This is a procedure that
widens damaged arteries using a narrow tube that travels through your
blood vessels and has an inflatable balloon on the end that can help
improve circulation. A stent is often implanted at the same time to keep
the artery propped open. Once an artery is open, your doctor may place a
small metal or plastic mesh tube (stent) in the artery to keep it open.
* Vascular surgery. Your doctor may recommend surgery that takes a
healthy blood vessel from another part of your body to replace the
vessel that's causing your claudication. This allows blood to flow
around the blocked or narrowed artery.
* Hyperbaric chamber. If you have ulcers on your legs from severe
claudication, your doctor may recommend you sit in a hyperbaric chamber
to help your ulcers heal. A hyperbaric chamber is an oxygen-rich
environment that helps cuts and sores heal and promotes cell growth.

©
Lifestyle and home remedies

The plaques that have damaged your arteries are often the result of
unhealthy lifestyle habits. So a key part of treatment is stopping any
unhealthy habits and adopting healthy ones.

If you have claudication or peripheral artery disease, make sure you:

* Don't smoke. Smoking is the most significant risk factor for the
development and worsening of peripheral artery disease. Smoking
increases the chance that you'll eventually require an amputation or
even die of the disease. Avoid secondhand smoke too.
* Exercise. You may wonder how exercise can be helpful if that's
what brings on the claudication pain. Actually, exercise helps condition
your muscles so that they use oxygen more efficiently. So even if your
muscles are getting less oxygen, they can use what they do get more
effectively. That can eventually mean less pain during exertion. Your
health care team can help develop a supervised exercise program that
will enable you to gradually increase the distance you're able to walk
without pain and increase your overall mobility.
* Know and control your cholesterol levels. If your cholesterol
levels aren't what they need to be, your doctor may recommend medication
to get them to the proper levels. A meal plan that includes a variety
of low-fat foods, emphasizing fruits, vegetables, grains and legumes,
can help too. Combined with exercise, a healthy diet can help control
your blood pressure and cholesterol levels, both of which can contribute
to atherosclerosis.
* Avoid certain medications. Don't use drugs that cause your blood
vessels to constrict. Many sinus and cold medications sold
over-the-counter contain pseudoephedrine, which is known to constrict
blood vessels. Ask your doctor if there are any other medications you
need to avoid.
* Avoid injury to your feet and legs. Reduced blood flow increases
your risk of complications from injuries. Choose well-fitting shoes that
will protect your feet if you are participating in activities or work
that might lead to injury.

©
Coping and support

It can be frightening to learn that the reason you're having pain is
that your blood vessels are narrowing. Learning all you can about what's
causing your claudication can put you in control, and you'll know
exactly what steps to take to ease your pain.

Some people also find it helpful to talk with other people who are going
through the same thing that they are. In a support group, you may find
encouragement, advice and maybe even an exercise partner or two. Ask
your doctor if there are any support groups in your area.

©
Prevention

The best way to prevent claudication is to maintain a healthy lifestyle. That means:

* Quit smoking if you're a smoker.
* If you have diabetes, keep your blood sugar in good control.
* Exercise regularly.
* Lower your cholesterol and blood pressure levels, if necessary.
* Eat foods that are low in saturated fat.
* Maintain a healthy weight.
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