There’s No Tiptoeing Around Peripheral Artery Disease
If a tightness in your legs is literally cramping your style, making it hard to walk short distances without resting, you are not alone. Millions of Americans experience peripheral artery disease (PAD). Recognizing the condition early is a critical first step in slowing its progression.
Many patients with PAD may have no symptoms or only mild symptoms, said Britt H. Tonnessen, MD, a vascular surgeon at Yale New Haven Hospital and associate professor of Surgery at Yale School of Medicine. “The most common symptom of PAD is intermittent claudication, which is defined as pain in the calf that occurs during mild exercise and is relieved by a short period of rest,” she said. “For example, a person may walk to their mailbox and experience tightness and aching in one leg or both. If they stop and stand for a bit, the pain goes away.”
People may also experience symptoms in the lower leg or foot such as coldness, numbness or weakness. Complications of PAD caused by atherosclerosis, a condition characterized by the gradual buildup of plaque inside the arteries, can lead to:
- Acute limb ischemia – a sudden decrease in blood flow to the legs that threatens circulation to the limbs. Symptoms include sudden pain and loss of feeling or movement in the foot, with associated coldness and discoloration. It is an emergency because there is a high risk of amputation and even death if left untreated. Main causes include thrombosis (a blood vessel blockage), embolism (blood clots) and trauma due to previous heart surgery.
- Critical limb ischemia – an injury or infection that causes tissue to die. Symptoms include open sores on the limbs that don't heal. Treatment may include amputation of the affected limb.
Who’s at risk?
While untreated PAD can lead to devastating consequences, it doesn’t usually happen overnight. “Most patients with claudication have stable symptoms over time. And some patients can improve, particularly if they are able to modify their risk factors,” Dr. Tonnessen said.
She noted that smoking and diabetes are the two most common risk factors. Additional risk factors include a history of high blood pressure (hypertension) and high cholesterol and, often, a personal or family history of heart disease. Patients with end stage renal disease (ESRD) on dialysis are also at greater risk for PAD.
Treating PAD
Screening for PAD can be as simple as checking pulses and measuring the blood pressure in the foot versus the blood pressure in the arm. Treatments vary and are based on symptoms as well as the degree and location of the vascular disease.
“The diagnosis always starts with a good history of symptoms and a physical exam. There are many causes for leg and foot pain that can be mistaken for PAD,” Dr. Tonnessen said.
For patients with mild symptoms, the first line of treatment is a medical management approach. This includes a careful review of your risk factors and determining which factors can be improved. “The initial treatment for most people is to quit smoking and engage in a supervised walking-exercise program,” she said.
Most patients with PAD also benefit from an antiplatelet medication, such as aspirin, and a medication to lower cholesterol. Good hydration is also important and may help with symptoms.
If your symptoms have progressed to the point where you are experiencing pain while resting or you have a wound that is not healing, you may be a candidate for interventional treatment with a vascular specialist, Dr. Tonnessen said.
Interventional treatments include:
- An angiogram – a test in which fluid is injected into the bloodstream to make blood vessels visible on a scan to help detect abnormal blood vessels and clots.
- Endovascular therapy – a minimally invasive procedure that involves inserting stents into the blood vessels to modify blockages and restore blood flow. Patients who undergo endovascular therapy may be able to go home the same day.
- Open bypass surgery – a procedure used in more severe cases to redirect blood flow around blocked blood vessels by creating a new pathway for blood flow using a graft or pieces of a vein or artery. Depending on the procedure, bypass surgery on a lower extremity can take four to six hours, requires a hospital stay of several days and often several weeks of rehabilitation.
Expert, Experienced Care for PAD
“Yale New Haven Health Heart and Vascular Center has highly experienced experts in vascular surgery and endovascular therapy who offer both standard and cutting-edge treatments for PAD. We are uniquely trained and experienced to weigh available treatment options, carefully exploring the pros and cons of each treatment,” Dr. Tonnessen said. “We also offer novel treatment options for patients for whom traditional methods may have been unsuccessful. By offering the entire spectrum of treatments, we can assure patients that they are receiving the most appropriate therapy.”
Learn more about Heart and Vascular Services at Yale New Haven Hospital.
Know the Warning Signs of Suicide. Is Your Child at Risk?
It’s a sobering fact. Suicide is a leading cause of death among young people in the United States. The topic is difficult to talk about – but it is one that can save lives.
Every year, approximately 2 million adolescents attempt suicide. According to the Children’s Hospital Association’s Pediatric Health Information System, suicide attempts, ideation and self-injury among children from ages 5-18 have become the most common behavioral health condition seen in children’s hospitals’ emergency departments nationwide.
Experts say that there several factors behind these numbers. “Since the COVID-19 pandemic, rates of ED visits for behavioral health disorders in children and adolescents have increased dramatically. One of the reasons for this rise was disruption to access to behavioral health care,” said Kirsten Bechtel, MD, a pediatrician in the emergency department at Yale New Haven Children’s Hospital (YNHCH) and professor of Pediatrics and Emergency Medicine at Yale School of Medicine.
“There is also evidence to support the idea that exposure to social media may be making more children and adolescents depressed and anxious,” she said.
Other risk factors include a family history of suicide, stressful life events, the presence of mood disorders with no behavioral health treatment, substance use, poor parent-child communication and school problems.
Warning signs of suicide
According to Dr. Bechtel, various behaviors should raise concern.
Immediately call 911 if you observe someone:
- Saying they want to kill themselves or threatening to hurt or kill someone else
- Looking for ways to kill themselves, such as seeking access to pills, weapons or harmful activities
- Talking or writing about death, dying or suicide, either verbally, in a note or on social media postings
Additional warning signs include:
- Feelings of hopelessness
- Increased substance use
- Withdrawal from friends, family
- Inability to sleep or sleeping all the time
- Drastic mood changes (rage, sadness)
- Sudden/drastic giving away of belongings/treasures
What should you do if you see warning signs?
Address the situation directly and don’t be afraid to be blunt. “The first step is to acknowledge that you see the signs and that you are concerned about the person. Ask the child or adolescent if they are thinking about hurting or killing themselves,” she said. “Don’t be afraid to ask. It does not increase the risk of death by suicide and may actually help to save that person.”
If you are worried that a child or adolescent is suicidal, you should just ask and not wait for warning signs to occur, said Pamela Hoffman, MD, a child and adolescent psychiatrist at Yale Child Study Center and assistant professor of Child Psychiatry at Yale School of Medicine who sees patients at Yale New Haven Children's Hospital Pediatric Emergency Department.
“Asking about suicidal thoughts doesn’t make a child have suicidal thoughts. But it does help give you knowledge when they have those thoughts, and it helps the child realize that they can talk about it with you,” she said. “Disclosing feelings of suicide become acceptable instead of forbidden.”
In 2022, a national hotline was created to provide free and confidential support for anyone in a crisis including those in emotional distress or behavioral health crisis. Anyone — the person in crisis, or someone supporting a person in crisis — can text or call 988 in the United States through any landline, cell phone, and voice-over internet device.
The 988 Lifeline differs from 911, which dispatches emergency medical services, fire and police. A 988 call may lead to activation of the 911 system if there is imminent risk to someone’s life. Connecticut residents can also call 211 to be connected with essential services and resources, including support for health evaluation, intervention and suicide prevention.
Strategies for risk reduction
Experts advise: Put time and space between someone who is experiencing suicidal thoughts and their access to lethal items. “By making access to lethal means a little more difficult, it gives a chance for impulsive thoughts of suicide to pass,” Dr. Hoffman said.
Firearms, for example, are used in almost half of suicides among adolescents and children, according to the Centers for Disease Control and Prevention.
“It’s important to consider the presence of guns in the home. While it’s safest to have a gun-free home to decrease the risk of suicide, if a firearm is present it should be unloaded and locked up separately from the ammunition. Ammunition should also be locked away,” Dr. Bechtel said.
Other potentially dangerous items to secure include medications, knives and ligatures.
Dr. Bechtel also recommends QPR training, which teaches you how to recognize the warning signs of a suicide crisis and how to “question, persuade and refer” someone to get help.
“Children and adolescents should be appropriately screened for mental health disorders as part of a holistic approach to health and well-being. If a mental health or substance use concern is brought to light, referrals to community resources and mental health providers can be lifesaving,” she said.
YNHHS Rolls Out Healthcare Hub on Wheels
Yale New Haven Health System and Yale Medicine have launched the first mobile retail pharmacy and clinic in the nation to bring health care to people where they live.
The project, known as InMOTION, serves communities throughout Connecticut, which is the first state in the country to legalize mobile retail pharmacy services. It features a mobile health unit in which patients can be seen by a clinician, have blood drawn if needed and receive their prescriptions all in one visit – without having to go anywhere else. People can also be checked for chronic diseases like diabetes and heart disease, monitor their blood pressure, and receive wound care and specialty services for infectious diseases such as HIV and hepatitis C. Addiction services, including treatment for opioid and alcohol use disorder and naloxone distribution, and mental health care are also available. Patients can also connect with social services resources that help with transportation, housing and employment.
“Access to medications and comprehensive medication management is especially challenging for underserved populations. Not only do they lack convenient access to a pharmacy, but they can also be unable to navigate programs designed to help them address their medication needs. This is where the mobile pharmacy can really make a difference,” said Osama Abdelghany, PharmD, executive director of the oncology pharmacy at Yale New Haven Health.
View the mobile pharmacy van schedule and services, as well as an appointment request form.
Learn How to Monitor Your Cholesterol
Yale New Haven Health offers “Curb Your Cholesterol," a self-monitoring program to help you reduce your cholesterol levels. This program gives you tools to improve your cholesterol numbers and includes weekly coaching sessions. The program is ideal for those diagnosed with high cholesterol levels or other heart-related conditions. Learn more about the “Curb Your Cholesterol" program by calling 203-200-3719.
Smilow “Beyond Beauty Program” Workshops Open for Registration
If you’re a current Smilow Cancer Hospital patient who is experiencing temporary visual changes to your hair, skin and nails while undergoing chemotherapy and radiation treatment, consider attending the free Beyond Beauty Program, to be held Sept. 18 from 2 - 4 pm at Smilow Cancer Hospital at North Haven Medical Center, 6 Devine St., North Haven.
The interactive workshop is provided by licensed cosmetologists, certified hair and wig specialists and The Cingari Family Boutique.
You must pre-register to receive your makeup toolkit on the day of the class. Class size is limited. To sign up, call the Cingari Family Boutique at 203-200-2273 (CARE) or send an email to [email protected].
If you can’t make the North Haven class, ask about additional upcoming workshops in Stamford, Trumbull, Derby and Guilford; and in Westerly, RI.
Take a Walk and Chat with YNHH Doctors
Take a walk and chat with local doctors as part of Yale New Haven Hospital's Get Healthy Walk ‘N’ Talk with a Doc. Walks are each Saturday through September along the Farmington Canal Greenway Trail in New Haven. Please arrive by 8:45 am. Walks begin at the entrance on the corner of Shelton Avenue and Starr Street and last approximately one hour. Parking is available at New Freedom Missionary Baptist Church, 280 Starr St., New Haven. For more information, email Andy Orefice or call 203-688-5671.
Find a Provider at YNHH
Are you looking for a physician? Call 888-700-6543 or visit our Find a Doctor feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience.
Billing Questions?
Yale New Haven Health offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.
