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Joey Wahler (Host): It can cause significant circulation issues. So, we're discussing peripheral arterial disease, also called PAD. Our guest is Dr. Sagar Gandhi. He's a vascular surgeon.

This is Flourish, the podcast from Prisma Health. Thanks so much for joining us. I'm Joey Wahler. Hi, Dr. Gandhi. Welcome.

Dr. Sagar Gandhi: Hey, thank you so much for having me.

Host: Thank you so much for making the time. First, simply put, for those unfamiliar, what is PAD?

Dr. Sagar Gandhi: PAD is peripheral arterial disease, as you said. And basically, it's blockages in the leg arteries that preevent prevent, blood from getting down to the feet.

Host: And so, what would be the symptoms of this?

Dr. Sagar Gandhi: Yeah. So, most of this goes undiagnosed until it's in its later stages. But the first symptoms people can have is anywhere from muscle cramping or your muscles wearing out, especially when you walk or run. And then also, you can even present with a wound on your foot that's not healing.

Host: So, why the feet?

Dr. Sagar Gandhi: Well, so if you think of it, the blood comes down from the heart. And the feet are really the farthest thing from it. And so, if you have multiple blockages or even a long segment blockage, you have trouble getting the blood down to the farthest part from your heart.

Host: That certainly makes sense. So because of the fact that, as you said, there are typically no symptoms until this thing has progressed, that makes risk factors more important for people to be aware of, right?

Dr. Sagar Gandhi: You're absolutely right. So, things like controlling your blood sugar if you have diabetes, stopping smoking, getting out and exercising, controlling your cholesterol levels, all those things help reduce the chances of PAD.

Host: So, someone that's overweight, especially significantly, so someone that's diabetic, how much more likely would they be to get this?

Dr. Sagar Gandhi: Unfortunately, they're a lot more likely. I would say up to 30-50%.

Host: And so, what are the things that people need to be mindful of if they're in that risk factor category, to try to keep this at bay?

Dr. Sagar Gandhi: So, I think the big thing is to pay attention to symptoms. If you're having that leg pain while you walk., Especially in the muscles, if you have a foot wound that's not healing. Something as simple as just checking your feet daily. Because, unfortunately, as you said, diabetics tend to get PAD and they tend to get foot wounds. They also get neuropathy where they can't feel their feet or feel their toes. And so, they can get a small cut and not even realize it. But the biggest thing you can do is just try to live a well-balanced, healthy lifestyle.

Host: Absolutely. So, how is PAD diagnosed by someone like yourself?

Dr. Sagar Gandhi: So typically, when you come in and you have some of these symptoms, we first start by doing a physical exam, which is just simply checking pulses in the groin area, on the top and the side of your foot. If we feel some diminished pulses or we don't feel pulses there, we can get a simple ultrasound or even we can measure blood pressure in your feet compared to your arms, which will give us an indication on percentage blockage.

Host: And so, are there situations where the pulse is at a healthy level in one part of the foot, not so in another?

Dr. Sagar Gandhi: Absolutely. If you think of your blood vessels, just like plumbing and pipes, you can have good pressure. And then, downstream, if you have a blockage on the other side of that blockage, you don't have a good pulse because the pressure is so low.

Host: Gotcha. And so, how is this typically treated?

Dr. Sagar Gandhi: So typically, first thing is lifestyle modification, like we talked about; risk factor control, stop smoking, get your blood sugar under control, control your cholesterol. That'll prevent the disease from getting worse. We start out by people on a supervised exercise plan that can improve their walking distance and actually help reduce the pain they have when they walk.

Now if you present with more severe peripheral arterial disease, like a foot wound, at that point, we need to be more aggressive. Things like doing endovascular interventions like balloons or stents in the legs to reopen the blockages, or even if it's a long segment, potentially a bypass or surgery to clean out that artery.

Host: And so, how do you go about determining which treatment is best in a particular case?

Dr. Sagar Gandhi: Well, I think based on the level of symptoms you're having, so if you present with severe peripheral arterial disease like a foot wound, that's not healing. We've gotta pull out the bigger guns, and that typically means some sort of procedure, like a stent or even a bypass. If you come in with milder symptoms and we've caught it early, we can put you on a supervised exercise plan, potentially give you some medication that will improve your blood flow, and we can prevent the progression of the disease.

Host: So when you talk about progression, at what point does this start to become alarming?

Dr. Sagar Gandhi: Well, it depends on your definition of alarming. So if you're a businessman who has to walk through the airport to get from the terminal to another terminal, and you can't make that walk, because your legs quit on you and you're missing flights, or if you work in a warehouse and you can't walk from one side of the warehouse to the other, that can be alarming. That puts your livelihood at risk. Of course, when you talk about limb loss, meaning you'll lose your leg or lose your foot, that's when you get the foot wounds that aren't healing, those are at risk of having limb loss

Host: And I am going to ask you more about that in just a moment. But first, when this is treated, is the goal to reverse it or simply to manage? Can it be reversed?

Dr. Sagar Gandhi: So, I think both depending on the presentation. So first and foremost, we want to manage and prevent progression of peripheral arterial disease, and that would be the medical management and the lifestyle modification we talked about. But if you show up with more severe disease, like a foot wound, we need to put a stent in, do a bypass, and basically reverse some of the effects.

Now, unfortunately, or fortunately, our bypasses are heavily dependent on how the patient chooses to live their life moving forward. Meaning, if you continue to smoke and your blood sugar is still bad, then whatever we do is not going to be effective in the long-term.

Host: Now, when you talk about some of those things that you mentioned in terms of lifestyle changes, diet and exercise in particular. In addition, there are some home remedies, if you will, right? Like. Tell us about elevating the legs, how can that help?

Dr. Sagar Gandhi: So, leg elevation is really good for venous disease, especially if you have chronic leg swelling and you have varicose veins. For peripheral arterial disease, it may not be the best, especially if you have more severe peripheral arterial disease.

Host: And then, what about applying heat to the feet?

Dr. Sagar Gandhi: So, I think heat can be nice, especially it can help with some of the discomfort that you're feeling. But typically, heat is good for arthritis type of pain. A lot of diabetics get peripheral arterial disease. And as I said earlier, they may not be able to feel that temperature on their legs and actually can burn some of their skin. So, it could actually be detrimental.

Host: So, I want to go back to diet and exercise. If people listening are affected by this and want to make just one change in their diet to get started down that road, what would you recommend?

Dr. Sagar Gandhi: I think avoid fried foods. I think that grilling, baking, things like that are much better than frying your foods. You know, try to reduce the amount of oil and butter that you use. And I think that'll make a huge difference.

Host: That's a really great piece of advice. And how about in terms of exercise? Kind of same church, different pew here as they say, Doc. If someone wants to just do one thing to get started with being more active, being more mobile to increase the circulation in those feet, what should they do?

Dr. Sagar Gandhi: It's something very simple. Just walk. And by that I mean intentional walking. Either walk around your neighborhood, walk around the track, at your local park, take your dog for a brisk walk. I think the intentional walk is really the most important thing. And by intentional, I mean walk for the sake of walking. People tend to go to the grocery store and they say, "Oh, I walk the whole grocery store." But if you think about it, you stop every aisle or two and grab something or look at something. What you really want to do is walk and exercise, meaning go ahead and turn a stopwatch on. Figure out how long you can walk, walk a mile, walk five minutes, whatever you can do, and then just try to slowly increase that walking time and walking distance over the next several weeks.

Host: Yeah. You want to walk like you are late for an appointment as opposed to walking like you're taking a stroll in the park. Couple of other things. How about vitamins or supplements? Can they be helpful here?

Dr. Sagar Gandhi: Yeah, I think just having a well-balanced diet and anything your primary care says you need, such as magnesium can help some of the cramping. Staying well hydrated is probably the most important thing you can do if you have even mild peripheral arterial disease.

Host: Now, I saved the most potentially unpleasant subject here for toward the end of our chat. You touched on it earlier, losing a limb, losing a foot because of this condition becoming so bad. Can you talk to our audience about just how important it is to stay on top of this, try to ward it off, try to heed these warnings that you're giving to make sure it doesn't come to that?

Dr. Sagar Gandhi: Yeah. So unfortunately, if you do have severe PAD and you develop a foot wound, you risk of losing that limb is greater than 30%. More importantly, this is a check engine light, so to speak, meaning that you're not living your life right and you're not having a healthy diet. And really, you have another 30% chance of having some sort of cardiovascular-- meaning a heart attack, or a stroke, or even dying in the next year. So, preventing it from getting to that point is really important. But once you notice you have it, seeking medical attention quickly is also very important to try to halt the progression.

Host: And along those lines, Doctor, in summary here, it seems the advice you're giving isn't just about dealing with this condition, but through osmosis, if you do the things you need to to ward this off, you'll be living a healthier lifestyle overall, right?

Dr. Sagar Gandhi: Absolutely vascular surgery is a surgical treatment of a medical problem. Your medical problems have gotten so bad, now they're starting to manifest in different parts of your body, namely for PAD in your legs.

Host: Well, folks, we trust you are now more familiar with peripheral arterial disease. Dr. Gandhi, keep up all your great work valuable information indeed, and thanks so much again.

Dr. Sagar Gandhi: Thanks again for having me.

Host: Absolutely, And for more information, please visit prismahealth.org/flourish. If you found this podcast helpful, please do share it on your social media and be sure to explore our entire podcast library for topics of interest to you. I'm Joey Wahler. And thanks again for being part of Flourish, the podcast from Prisma Health.