Listen in as Niraj Parekh, MD, a cardiologist and member of the Medical Staff at Temecula Valley Hospital, discusses Peripheral vascular disease and the treatments available at Temecula Valley Cardiology Medical Group.
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Do You Suffer from Peripheral Vascular Disease?
According to the National Institutes of Health, one in every 20 Americans over the age of 50 has P.A.D., a condition that raises the risk for heart attack and stroke.
Featured Speaker:
He completed his Internal Medicine residency at the University of California, San Diego and went on to Loyola University in Chicago for his General and Interventional Cardiology fellowships. He now returns to Southern California to be close to family and friends. Dr. Parekh is board certified in Interventional and General Cardiology, Echocardiography, Nuclear Medicine, and Vascular Study Interpretation. He specializes in percutaneous interventions of the coronary arteries as well as using this non-surgical technique to repair structural heart disease including but not limited to atrial septal defects, patent foramen ovale, and aortic stenosis.
Learn more about Niraj Parekh, MD
Niraj Parekh, MD
Niraj Parekh, MD, is a cardiologist and a member of the Medical Staff at Temecula Valley Hospital.He completed his Internal Medicine residency at the University of California, San Diego and went on to Loyola University in Chicago for his General and Interventional Cardiology fellowships. He now returns to Southern California to be close to family and friends. Dr. Parekh is board certified in Interventional and General Cardiology, Echocardiography, Nuclear Medicine, and Vascular Study Interpretation. He specializes in percutaneous interventions of the coronary arteries as well as using this non-surgical technique to repair structural heart disease including but not limited to atrial septal defects, patent foramen ovale, and aortic stenosis.
Learn more about Niraj Parekh, MD
Transcription:
Do You Suffer from Peripheral Vascular Disease?
Melanie Cole (Host): According to the National Institute of Health, one in every 20 Americans over the age of 50 has vascular disease--conditions that can raise the risk for heart attack and stroke. My guest today is Dr. Niraj Parekh. He’s an interventional cardiologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Parekh. Tell us about the difference between people hear the words vascular disease, peripheral vascular disease, peripheral artery disease. Explain what those are.
Dr. Niraj Parekh (Guest): The way I look at it is that, I always look at broad definitions and then try to narrow it down. So, I think of vascular disease as through the umbrella that incorporates everything endovascular, peripheral vascular, peripheral arterial. Peripheral vascular and peripheral arterial are very similar; however, nowadays we’re treating endovascular, endovenous as well as lower extremity arterial. So, the way I look at it is I make this umbrella of vascular disease and that incorporates all entities. So carotid disease, subclavian disease, aorta disease, low extremity arterial disease, as well as lower extremity venous disease which is up and coming treatment now for patients as well with endovascular, endovenous ablation. So, that’s how I generalize . It is a common thing for patients and for physicians even to say peripheral arterial disease and peripheral vascular disease but to me it’s very limited only to lower extremities. I think that we as healthcare providers are limiting the screening we offer and the testing we offer to our patients if we only limit it to the lower extremities.
Melanie: So, doctor, do we know some of the risk factors or causes of some of these vascular diseases?
Dr. Parekh: Yes, there is very similar to heart artery disease, coronary artery disease. So, if you have coronary artery disease, that is considered an equivalent of vascular disease or peripheral arterial disease, if you want to be more specific for now. Same as if you have peripheral arterial disease, it’s an equivalent to coronary. So, they’re one to one as far as risk factor. Other risk factors are diabetes, high blood pressure, high cholesterol, family history, weight, obesity, especially we’re beginning to see more and more patients that we try to do BMIs on, if they have high BMIs it’s considered another risk factor for them.
Melanie: And, how would somebody know? You don’t typically always check for some of these things in an annual physical. Are there some symptoms that would send somebody to see an interventional cardiologist such as yourself?
Dr. Parekh: Yes. The symptoms range from lifestyle limiting symptoms like claudication or pain in the lower extremities, pain in the feet, pain in the calves, pain in the hip or thighs with activity. That would mean that there is a blockage somewhere in the aorta or in the lower extremities limiting flow to them when the patient is walking, say, a mile or half a mile. They will tell us that, “After I start to walk little bit I’m okay, but when I start to walk half a mile or a mile, I start to have cramps in my calves or my thighs.” That’s a sign of blockage in the artery.
Melanie: If you do diagnose somebody with it--tell us about some of the diagnostic tests. How do you know that that’s what they have?
Dr. Parekh: So, what we do is we have non-invasive vascular studies. It’s called non-invasive vascular studies or vascular medicine compared to interventional vascular therapies. That incorporates arterial ultrasounds and dopplers. So, what we do is we measure flow with a doppler from the hip down to the feet and we see if the flow is diminished at any level in the hip, the thighs, the knees or in the feet. We’re able to localize the area of blockage based on that. We also have ultrasounds. We can also look at the actual arteries themselves to see if there is any narrowing in any specific area from the top to the bottom. The last one is really a simple one. Everyone that has diabetes, whether they have symptoms or not should be screened for this. It’s called an “ankle brachial index”. This is a measurement that basically we do a blood pressure cuff in the arm and a blood pressure cuff in the leg, and we compare. They should be very similar pressures in the ankles and in the brachial and the upper arm. If it’s lower in the legs, that means that it’s a sign of a flow problem. It’s a very simple screening test that I believe many patients with risk factors such as heart disease, artery disease, coronary artery disease or diabetes should have done in the family physician’s office or their cardiologist’s office.
Melanie: So, if you do diagnose somebody with a vascular disease, what’s the first line of defense? How do you treat it?
Dr. Parekh: So, if we know that they do have—it depends on their level of the disease and the severity of it. If there are borderline blockages that we can manage medically, we try that at first meaning. We try to put them on--we aggressively control their diabetes, their blood pressure, their lipid profile, their cholesterol, have them walk. Ambulating is the biggest--data shows that helps the patient the most overcome these blockages by developing extra channels, improving the flow, and even reducing the percentage of blockage that there is already existing. So, we try lifestyle modification and risk factor modification first prior to doing interventional treatment, if there is borderline. If there is critical blockage, meaning 99% blockage in the hip or the thigh artery, then we do try to go in there invasively and interventionally, and to do angioplasty and stenting to open it up to get flow because that we know would not improve just by controlling their cholesterol or having them walk. Now, this is for symptoms patients. Patients that have actual ulcers in their feet, meaning gangrene, dry gangrene, non-healing wounds, they’re diabetic, they have vascular disease or arterial blockages, those don’t get better until we open up the blockages and revascularize them because then they won't heal.
Melanie: One of the things that sometimes is a limiting factor, and you mentioned exercise and moving, is that moving can cause that claudication. What do you tell people when they say, “Well, I’m trying to exercise. I get on the treadmill but it hurts my legs when I do that”?
Dr. Parekh: Well, we do try to encourage them to push through that. We try to tell them go to the time--up to the time that it causes their symptoms but do it more often. So, increasing their frequency and then slowly increasing their duration helps to try and overcome that effect. There are certain medications for the lower extremities like Pletal and things that can help improve the flow without doing angioplasty and stenting that will help the overcome this limitation when walking, and once they do that, we can back off on the medication in the future.
Melanie: So, give your best advice for people to live with peripheral arterial disease, peripheral vascular disease, this whole combination of vascular diseases. What do you want them to know about getting a healthy lifestyle and living within managing the symptoms of this vascular diseases.
Dr. Parekh: I think the first advice would be to make sure that you get all the screening, to make sure that you don’t have--you follow up with your family physician. Make sure that you’re getting checked for diabetes, making sure your lipid profile is being checked routinely, make sure you’re adhering to the recommendations to keep your body mass index where it should be, meaning not have any problem of obesity as well as watching how much you eat ins and outs. I think there are lot of different dietary plans out there but my belief is that if you can balance the calories that you bring in and the calories that you can burn off, that’s the best way to try to maintain weight or lose weight. So, I think those are the first things that make you aware: do you have diabetes or you do not have diabetes, like I said. With vascular disease, similar to cardiac disease, diabetics are high risks patients for developing it, and at the same time they can get silent issues. So, they can get silent ischemia in the heart. Patients can have silent heart attack, they can have silent--they get a cut in their foot, they think they’ll be fine. They might not even have nerves there because diabetes has lost the nerve endings there and they may not feel that they have a problem there and then, the next thing you know it’s an ulcer or a wound or gangrene, and they have to have their foot amputated. I think screening and testing by a family physician probably is the first initiative and then, subsequently, if they do have that diagnosis, to be very aggressive in controlling those risk factors.
Melanie: And, why should they help you come to Temecula Valley Hospital for their care?
Dr. Parekh: Well, I think that we’re considered a cardiovascular center now in this area. We have very advanced imaging modalities to be able to diagnose and treat. We have a very good non-invasive vascular lab with a radiologist to help us figure out if there is arterial disease or vascular disease, as I mentioned earlier. If they do have that, we have an angio suite where we’re able to do interventional procedures to help alleviate their symptoms and their ulcers if they needed it.
Melanie: Thank you so much for being with us today. You're listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to www.temeculavalleyhospital.com. That's www.temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Do You Suffer from Peripheral Vascular Disease?
Melanie Cole (Host): According to the National Institute of Health, one in every 20 Americans over the age of 50 has vascular disease--conditions that can raise the risk for heart attack and stroke. My guest today is Dr. Niraj Parekh. He’s an interventional cardiologist and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Parekh. Tell us about the difference between people hear the words vascular disease, peripheral vascular disease, peripheral artery disease. Explain what those are.
Dr. Niraj Parekh (Guest): The way I look at it is that, I always look at broad definitions and then try to narrow it down. So, I think of vascular disease as through the umbrella that incorporates everything endovascular, peripheral vascular, peripheral arterial. Peripheral vascular and peripheral arterial are very similar; however, nowadays we’re treating endovascular, endovenous as well as lower extremity arterial. So, the way I look at it is I make this umbrella of vascular disease and that incorporates all entities. So carotid disease, subclavian disease, aorta disease, low extremity arterial disease, as well as lower extremity venous disease which is up and coming treatment now for patients as well with endovascular, endovenous ablation. So, that’s how I generalize . It is a common thing for patients and for physicians even to say peripheral arterial disease and peripheral vascular disease but to me it’s very limited only to lower extremities. I think that we as healthcare providers are limiting the screening we offer and the testing we offer to our patients if we only limit it to the lower extremities.
Melanie: So, doctor, do we know some of the risk factors or causes of some of these vascular diseases?
Dr. Parekh: Yes, there is very similar to heart artery disease, coronary artery disease. So, if you have coronary artery disease, that is considered an equivalent of vascular disease or peripheral arterial disease, if you want to be more specific for now. Same as if you have peripheral arterial disease, it’s an equivalent to coronary. So, they’re one to one as far as risk factor. Other risk factors are diabetes, high blood pressure, high cholesterol, family history, weight, obesity, especially we’re beginning to see more and more patients that we try to do BMIs on, if they have high BMIs it’s considered another risk factor for them.
Melanie: And, how would somebody know? You don’t typically always check for some of these things in an annual physical. Are there some symptoms that would send somebody to see an interventional cardiologist such as yourself?
Dr. Parekh: Yes. The symptoms range from lifestyle limiting symptoms like claudication or pain in the lower extremities, pain in the feet, pain in the calves, pain in the hip or thighs with activity. That would mean that there is a blockage somewhere in the aorta or in the lower extremities limiting flow to them when the patient is walking, say, a mile or half a mile. They will tell us that, “After I start to walk little bit I’m okay, but when I start to walk half a mile or a mile, I start to have cramps in my calves or my thighs.” That’s a sign of blockage in the artery.
Melanie: If you do diagnose somebody with it--tell us about some of the diagnostic tests. How do you know that that’s what they have?
Dr. Parekh: So, what we do is we have non-invasive vascular studies. It’s called non-invasive vascular studies or vascular medicine compared to interventional vascular therapies. That incorporates arterial ultrasounds and dopplers. So, what we do is we measure flow with a doppler from the hip down to the feet and we see if the flow is diminished at any level in the hip, the thighs, the knees or in the feet. We’re able to localize the area of blockage based on that. We also have ultrasounds. We can also look at the actual arteries themselves to see if there is any narrowing in any specific area from the top to the bottom. The last one is really a simple one. Everyone that has diabetes, whether they have symptoms or not should be screened for this. It’s called an “ankle brachial index”. This is a measurement that basically we do a blood pressure cuff in the arm and a blood pressure cuff in the leg, and we compare. They should be very similar pressures in the ankles and in the brachial and the upper arm. If it’s lower in the legs, that means that it’s a sign of a flow problem. It’s a very simple screening test that I believe many patients with risk factors such as heart disease, artery disease, coronary artery disease or diabetes should have done in the family physician’s office or their cardiologist’s office.
Melanie: So, if you do diagnose somebody with a vascular disease, what’s the first line of defense? How do you treat it?
Dr. Parekh: So, if we know that they do have—it depends on their level of the disease and the severity of it. If there are borderline blockages that we can manage medically, we try that at first meaning. We try to put them on--we aggressively control their diabetes, their blood pressure, their lipid profile, their cholesterol, have them walk. Ambulating is the biggest--data shows that helps the patient the most overcome these blockages by developing extra channels, improving the flow, and even reducing the percentage of blockage that there is already existing. So, we try lifestyle modification and risk factor modification first prior to doing interventional treatment, if there is borderline. If there is critical blockage, meaning 99% blockage in the hip or the thigh artery, then we do try to go in there invasively and interventionally, and to do angioplasty and stenting to open it up to get flow because that we know would not improve just by controlling their cholesterol or having them walk. Now, this is for symptoms patients. Patients that have actual ulcers in their feet, meaning gangrene, dry gangrene, non-healing wounds, they’re diabetic, they have vascular disease or arterial blockages, those don’t get better until we open up the blockages and revascularize them because then they won't heal.
Melanie: One of the things that sometimes is a limiting factor, and you mentioned exercise and moving, is that moving can cause that claudication. What do you tell people when they say, “Well, I’m trying to exercise. I get on the treadmill but it hurts my legs when I do that”?
Dr. Parekh: Well, we do try to encourage them to push through that. We try to tell them go to the time--up to the time that it causes their symptoms but do it more often. So, increasing their frequency and then slowly increasing their duration helps to try and overcome that effect. There are certain medications for the lower extremities like Pletal and things that can help improve the flow without doing angioplasty and stenting that will help the overcome this limitation when walking, and once they do that, we can back off on the medication in the future.
Melanie: So, give your best advice for people to live with peripheral arterial disease, peripheral vascular disease, this whole combination of vascular diseases. What do you want them to know about getting a healthy lifestyle and living within managing the symptoms of this vascular diseases.
Dr. Parekh: I think the first advice would be to make sure that you get all the screening, to make sure that you don’t have--you follow up with your family physician. Make sure that you’re getting checked for diabetes, making sure your lipid profile is being checked routinely, make sure you’re adhering to the recommendations to keep your body mass index where it should be, meaning not have any problem of obesity as well as watching how much you eat ins and outs. I think there are lot of different dietary plans out there but my belief is that if you can balance the calories that you bring in and the calories that you can burn off, that’s the best way to try to maintain weight or lose weight. So, I think those are the first things that make you aware: do you have diabetes or you do not have diabetes, like I said. With vascular disease, similar to cardiac disease, diabetics are high risks patients for developing it, and at the same time they can get silent issues. So, they can get silent ischemia in the heart. Patients can have silent heart attack, they can have silent--they get a cut in their foot, they think they’ll be fine. They might not even have nerves there because diabetes has lost the nerve endings there and they may not feel that they have a problem there and then, the next thing you know it’s an ulcer or a wound or gangrene, and they have to have their foot amputated. I think screening and testing by a family physician probably is the first initiative and then, subsequently, if they do have that diagnosis, to be very aggressive in controlling those risk factors.
Melanie: And, why should they help you come to Temecula Valley Hospital for their care?
Dr. Parekh: Well, I think that we’re considered a cardiovascular center now in this area. We have very advanced imaging modalities to be able to diagnose and treat. We have a very good non-invasive vascular lab with a radiologist to help us figure out if there is arterial disease or vascular disease, as I mentioned earlier. If they do have that, we have an angio suite where we’re able to do interventional procedures to help alleviate their symptoms and their ulcers if they needed it.
Melanie: Thank you so much for being with us today. You're listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can go to www.temeculavalleyhospital.com. That's www.temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.