Ease that pain in your leg, sole and heel

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By Dr. Victor Dumaguing

To Your Health

Saturday, May 18, 2013


MORE and more we see elderlies among us, more reverently called senior citizens, thanks for the increasing control of infectious diseases which used to be the number one cause of death in developing so-called Third World countries, which include our dearly beloved Philippines. Thus, health care givers meet more of the degenerative or growing-old related ailments like arthritides, the most common of which is osteoarthritis (rayuma in local parlance). Along with joint pains are all sorts of pain- from mere nagging discomfort to the excruciating wrenching pain.

Peripheral arterial disease is one of the more common maladies affecting our baby boomers- those born after World War II, and of course, their older siblings. The pathology of peripheral arterial disease (PAD) is gradual narrowing of the lumen or opening of the arteries. We all know that arteries are the blood vessels that bring life-giving oxygen and life-sustaining nutrients to all of the 75 trillion cells of the adult human body. Thus, with a gradually constricted narrowed leg artery, the first symptom is a painful, aching, cramping or tired feeling in the leg muscles during physical activity-= this feeling in medical lingo is called intermittent claudication. Muscles hurt when the person walks and the pain comes in faster and becomes more severe when the person walks rapidly or is walking uphill. Most commonly, the pain is on the calf muscles or leg muscles- gastrocnemius, soleus, plantaris whose conjoint tips from the tendon of Achillles. However, other parts can also be as badly affected like feet, thigh, hips, and buttocks, depending on the location of the narrowing. The pain can be relieved by resting. Usually after 1-5 minutes of sitting or standing, the person can walk the same distance already before feeling the pain again.

As the disease gets worse the distance the person can walk without pain gets shorter. Eventually, the muscles may ache even at rest, thus interfering with a restful sleep. Pain gets more severe when the legs are elevated. A foot with severely reduced blood supply is usually cold, numb and bluish or cyanotic. The skin is dry and may even be scaly and the nail and hair may not grow ell. As obstruction worsens, the person may develop sores on his toes, sole and heel.

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Most people with PAD have atherosclerosis, a disease process in which fatty materials accumulate under the lining of the arterial wall gradually narrowing the artery, thus patients are advised to get their cholesterol, triglycerides and other blood lipids to normal levels. Smoking which through a cascade effect initiated by its nicotine, will result to constriction thus narrowing of the lumen op the arteries, must be stopped. An ideal blood pressure and a healthy weight would be a significant boost to improved circulation. Of course, we cannot overestimate the paramount value of exercise- brisk walking at least 30minutes a day.

And thank God, there is Cilostazol. This drug and several of its active metabolites are technically classified as phosphodiesterase III inhibitors. Phosphodiesterases are enzymes that inactivate or destroy Cyclic Adenosine monophosphate (cAMP) which prevents aggregation or clumping of platelets and also promotes vasodilatation. Thus, if you give a drug like Cilostazol that would inhibit phosphodiesterase, then cAMP is not destroyed, thus dilatation of blood vessels is sustained, improving oxygen and nutrient supply, hopefully easing the muscle and leg pains.

Trombocil is a popular trade name of Cilostazol, which comes in 50 and 100 mg strengths. Just like any excellent drug, Cilostazol has its contraindications and warnings like should not be given to pregnant women, those with congestive heart failure, those with bleeding tendencies like hemophilia and those with very fast heart rates like hyperthyroid patients. However, my experience and those of my colleagues have been very positive and in fact, beneficial to our patients. Now, they text me how much more distance they can reach before their leg muscles ache.

So, if you are bothered by the symptoms of peripheral arterial disease, you family doctor can evaluate and come up with its management. Meanwhile, with your kind indulgence, allow me to stretch the limits of my poetic license, for the sake of rhythm and rhyme- bothered by pain in your leg, sole and heel?, try Trombocil!

Published in the Sun.Star Baguio newspaper on May 18, 2013.

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