Prevention Is Main Weapon Against
Jonathan Towne, MD
Medical College of Wisconsin Vascular Surgeon
Named one of the "Best Doctors in America®" 2004 by Best Doctors, Inc.
Vascular disease attacks the blood vessels, the critical lifelines for every organ in your body. According to Jonathan Towne, MD, your best bet is to work now to minimize your risk factors.
Q. What is vascular disease?
Vascular disease is disease of blood vessels, usually disease of arteries. It has many manifestations, because every organ system in the body is fed by arteries.
With vascular disease to the kidneys, you can have high blood pressure or renal failure. Vascular disease to the legs can cause claudication, which is pain in walking — you run the risk of losing a leg. With vascular disease to the head, it's strokes and stroke symptoms. When vascular disease involves the abdominal aorta, it can result in aneurysms. With vascular disease to the heart, heart attacks. it's the same disease process in all vessels.
It is related to a genetic predisposition — if your dad had heart disease, you are more likely to get it —and it is aggravated by diabetes. By and large, vascular disease is what kills diabetics.
Q. What are the symptoms and warning signs?
Exercise can sometimes increase your blood flow eight or ten times. So the first sign of vascular disease, in the legs for example, is that when you exercise and your body asks you to increase the flow of blood, you cannot do it. It's manifested as pain — classically in the calf of the leg. It can involve the foot, but usually it's the calf.
As the vascular disease gets worse, the distance you can walk before you have problems gets less and less. Finally you get to the point where you have pain at rest, and that means that now the supply of blood to your lower extremities is so low that it's not meeting the resting metabolic needs of the tissue. That pain issues in the foot, usually the forefoot, because that's the furthest from the heart. The next thing to happen is you develop gangrene — that's the death of tissue. Sometimes a patient will tell you, "I can't keep my leg in bed with me." It hurts to have the leg up. They have to have the leg down, so they sleep sitting in a chair or put their leg on the side of the bed. A lot of times the force of gravity will help get a little extra bit of blood down that can help keep the pain away.
Q. How do you treat vascular disease?
If you decide to treat the vascular disease, one of the ways to do that is to get an angiogram [an X-ray procedure that images arteries]. That tells you where the blockage is. The second step is to determine whether it is something you can treat with an angioplasty and/or a stent [a small lattice tube that holds open a blood vessel]. Angioplasty and stents are not quite as durable as bypass operations, but they are not front-end-loaded with the morbidity and mortality of the open procedure.
Q. What do you wish people knew about vascular disease?
They need to know smoking is awful. The other thing is our society needs to get with preventive medicine in the sense that people need to watch their diet, exercise and keep their weight down. We as human beings don't have any control over the genes that we have. But given whatever we have, we can maximize that. It's important to know what your grandma and grandpa died of, what your mom and dad and your siblings may have — to know what your medical history is. If they're not dying of heart disease, don't have hypertension, don't have diabetes, your chances of developing these are a lot less. If you have these things in your family, you need to really pay attention to what you should do.
The body is like a car. If you do good preventive maintenance, you're going to get more mileage out of it. You can't ask medicine and doctors to do it all. If you have the opportunity to avoid being my patient, that's the way to go.