Joey Wahler (Host): They're conditions that hamper blood flow between the heart and the legs or vice versa. So we're discussing vascular disease. Our guest, Dr. Hao Bui. He's a Vascular Surgeon with Dignity Health. This is Hello Healthy, a Dignity Health podcast. Thanks for listening. I'm Joey Wahler. Hi, Dr. Bui. Thanks for joining us.

Hao Bui, M.D.: Oh, hi Joey. Uh, thank you for having me on.

Host: Yeah, great to have you aboard. So first, tell us please what peripheral artery disease, also sometimes known as PAD, what is that exactly?

Hao Bui, M.D.: Peripheral artery disease, they often abbreviate it as PAD. It's a medical condition that affects the blood vessel outside your heart and brain. It typically involves the narrowing or clogging or hardening of this blood vessel, which we are known as arteries. Arteries are like the highway in your body that carries the blood from your heart to the rest of your body.

So when you have PAD, it's like those highways are getting blocked or narrow, usually due to building up of fatty deposits. We call it plaque. And because of this restriction of the blood flow to your limbs, sometimes you experience leg pain and uh, leg cramps when you walk and when you exercise, and in severe cases, when there's not enough oxygen or nutrition that feeds the tissues, you then develop some ulcers, and sometimes gangrene, sometimes that requires amputation. So, in simple terms, like PAD is a condition where the arteries that carries the blood from your heart to your tissues, and it gets blocked.

Host: Gotcha. Now next, can you explain what venous insufficiency is?

Hao Bui, M.D.: Venous insufficiency is a medical condition that occurs when the veins in our legs have difficulty returning the blood to your heart. In the veins, it has one way valves to help the blood flow against gravity. And sometimes those valves become leaky. And then it leads to pooling of the blood, and it leads to a range of symptoms. Sometimes you get swelling. You might notice swelling around your ankle and your legs, particularly when you're sitting or standing for a long period of time. When you get swelling, then you get pain and discomfort, and some people feel achy, heavy, throbbing sensation. Sometimes at home, when you get home, your legs feel fatigued, restless.

And then over time, sometimes those veins, because of the backflow of blood, they become dilated, they become varicose veins, or you call it twisted veins, spider veins. And then sometimes the blood gets out to the tissues, and then the iron in the blood stays behind into the skin, and you can see the little discoloration, like a little rusting of your skin down by the ankle. And sometimes if people don't do anything about it, they get a lot of swellings, and they develop into little ulcerations.

Host: And so besides, as you pointed out, the difference in the direction of the blood flow, between those two conditions; how do they differ?

Hao Bui, M.D.: Well, in terms of peripheral artery disease, the problem is with the arteries, and that's the pipes that carries the blood away from the heart to feed the legs. So the symptoms are different. Usually, with PAD, when you get pain when you walk. With venous insufficiencies, you usually get pain when you're at rest, when you're standing or you're sitting. Both conditions leads to pain, but what provoke it is different.

Host: Gotcha. So pain for both, but the way they manifest themselves is a little bit different. How about the demographic Doctor that's most at risk for these conditions? And what are some of those common risk factors for these two conditions?

Hao Bui, M.D.: The demographic for patients who has PAD or artery disease are usually in the elderly. They're in the male populations who are smokers, they're diabetics. They got high blood pressures, high cholesterol, and they have bad family history. Whereas venous or vein problems usually occur in females.

And the females who have multiple pregnancies, sometimes they are obese, or they have an occupational lifestyle where they sit or stands for a long period of time, such as like hairdressers, waitresses. But the common risk factors is age, you know, the older you get, the higher your propensity to develop bad pipes. Obesity is a major factor, and then just a sedentary lifestyle.

Host: Gotcha. And it's interesting you point out that some that work on their feet a lot are susceptible because we sometimes hear about people being apt to get other conditions when they're sitting all day at work, you know, whether it be carpal tunnel or what have you. But, I guess you can't win, right? If you're on your feet a lot, or if you're on your backside a lot, you got be careful in both instances, right?

Hao Bui, M.D.: Right, right. We humans were built to exercise, to walk. If we don't do it, we, we lose it.

Host: Absolutely. Use it or lose it they say. Right?

Hao Bui, M.D.: Right.

Host: So, what are the best preventative measures for both PAD and venous insufficiency?

Hao Bui, M.D.: Well, the best preventative for PAD is lifestyle modification. So, if you're a smoker, quit smoking. It's one of the most effective ways for you to reduce your risk of PAD. If you are diabetic, you want to control your blood sugars. You want your hemoglobin A1c like below 7. If you have high blood pressure, you want to manage it.

You want your systolic blood pressure to be less than 140. Because high blood pressure leads to injuries to those vessels. If you have high cholesterol, you want to take your statin. You want to engage in regular physical activity, like walking at least 30 minutes a day, swimming, cycling, because the more you do, the more you pump through those pipes. The more flow through the pipes, the cleaner the pipes stays.

And you got to kind of watch what you eat. What you put into those pipes, and you want to try to decrease the saturated fat, the cholesterol, and the sodium. Try to focus more on the fruit, the vegetable, the whole grain, or lean proteins like fish. And weight, you want to maintain a healthy weight.

Because if you have a lot of weight, that's put a lot of strain on your arteries. And then you have to manage your stress. If you have a lot of stress, that can lead to vascular problems. A lot of inflammation. So that's why people who are stressed tend to have heart attack and, leads to inflammations and that disrupts your pipes.

Host: So, especially if there's an underlying condition, it seems like you're saying that the old saying you're going to give me a heart attack, that can happen, huh?

Hao Bui, M.D.: Yes.

Host: So, a couple of other things here. If someone does in fact suspect they have one of these conditions; what are the next steps they should take? And when do you know the time is right to see an expert like yourself?

Hao Bui, M.D.: If you suspect that you have these conditions; I would recommend going and seeing your primary care doctor. And what they can do is they can speak to you about your medical conditions, trying to see if you have diabetes, high blood pressure, and cholesterol, try to control that.

They can do a physical exam on you. They can check your pulses. if you have good pulses, then it's unlikely you have artery disease, or they can do a test, what they call an ABI, where they put a little blood pressure cuff on your arm, and then by your ankle, and then measure the difference.

If you have blockages in the ateries, there'll be a difference in pressures, where they take that blood pressure. And then if you suspect that you have vein problems, again, you can see your primary care doctor, vascular surgeon, and we can discuss the symptoms, go through your medical history, and then for vein, sometimes we do an ultrasound, or they call it a duplex ultrasound, and what we do is we look at the blood flow. We see how your blood is flowing, see if your valves are closing.

Host: So primary care doctor first, and then perhaps eventually seeing a specialist like yourself. How about the best treatment options for someone that is in fact diagnosed with either of these conditions?

Hao Bui, M.D.: The best treatment options for the vascular conditions like peripheral arteries and venous insufficiency, it depends on the severity of the conditions. Let's take treatment options for peripheral artery disease. Most people with PAD, they don't have symptoms or are very mild. And that involves lifestyle modification, quit smoking, healthy diet, exercise, manage your diabetes, your high blood pressure and cholesterol, and that should be it.

Sometimes we put you on a medication, like aspirin sometimes a statin to decrease the progression of the disease. And sometimes we'll give you a medication called Cilostazol . What it does, it improves the blood flow a little bit. Now, when you start to have pain at certain distance when you walk, what we recommend is what we call exercise therapy, meaning you have to walk. You walk about 30 minutes a day. You walk to the point where it hurts and you walk a little more. And sometimes when the cases get more severe, and, you know, it's limiting your lifestyle, you starting to have pain all the time, you start having tissue loss, develop gangrene. And sometimes what we do is we can go into the artery systems, we can, do an angioplasty and can stent, try to open up that blockage, and sometimes we would have to do a bypass to kind of go around that blockage to try to bring more oxygenated blood to your tissues.

The other treatment option is for vein insufficiencies for venous, or the return blood is wear compressions stockings, compression therapy. Again, lifestyle, a lot of lifestyle. Avoid sitting a lot, be physical. Move your ankle, pumps your calf. Then try to avoid wearing like tight stuff around the waist. Makes it difficult for the blood to get back to your heart. And then if those things doesn't work and if you still have a lot of pain and symptoms, sometimes we can go in and we can close those veins down.

And it's an outpatient procedure. Sometimes it takes about 15 minutes to do. What you do is you go into the bad vein with a little catheter, and you can weld those veins closed. Or you can even go in with a little catheter and put some glue, and you glue those veins shut so it doesn't flow backward. And sometimes we have medication we can inject into it, and what it does is kind of scar down the vein.

Host: Wow. Interesting. So it sounds like there certainly are a number of options that are in play here, if you happen to be in one of these two situations. In summary, Doctor, to those treated for one of these conditions, what's your message about the basic quality of life they can expect once they've had the issue addressed?

Hao Bui, M.D.: Once they have the disease, it involves and require a lot of ongoing self care. It is that person's trying to maintain a healthy lifestyle, meaning they got to change the lifestyle that led them to that point. Meaning if they were smoker, they need to quit. If they're obese, needs to start exercising. If they have a sedentary lifestyle, start moving, start walking, start exercising.

Host: So in other words, the message there, it sounds like is after the doctor has done their job, the patient still has work to do moving forward. Yes?

Hao Bui, M.D.: Right. Uh, well, we don't have a cure for peripheral artery disease yet, or hardening of the arteries. So, the lifestyle and things that led you to that point will continue to keep going, if you don't change your lifestyle.

Host: Absolutely. And it seems that's the case with so many medical conditions. Well, folks, we trust you're now more familiar with vascular disease. Dr. Hao Bui, thanks so much again.

Hao Bui, M.D.: Oh, thank you, Joey, for having me. It was a pleasure.

Host: Same here. And for more information, please visit dignityhealth.org/Bakersfield. Again, that's dignityhealth.org/Bakersfield. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for listening to Hello Healthy, a Dignity Health podcast.