"Standing still on the street": Grant-funded program will help those with PAD
MORRIS — Leg pain is often seen as a normal part of aging, but for some people pain in the legs that increases during physical activity may be a symptom of a more serious condition, peripheral artery disease, or PAD.
Thanks to a grant from the Margaret A. Cargill Foundation, local physicians are hoping to raise awareness of this increasingly common condition and help promote independent living and healthy aging in community members who may be suffering from this condition.
Stevens Community Medical Center is the second rural health care provider to become part of the PAD Prairie Initiative, following shortly behind Lake Region Healthcare and Otter Tail County Public Health Department. The project is focusing on communities in rural Minnesota to help residents that may have limited access to programs and services.
Dr. Diane Treat-Jacobson, a professor in the school of nursing at the University of Minnesota, said the project is taking a three-pronged approach: raising community awareness of PAD symptoms and causes, educating physicians and nurses to recognize PAD, and offering supervised or community-based exercise therapy.
"Their plan is to help us screen our community, identify people who have this condition or may have this condition, and encourage them to follow back up with us in the clinic," added Dr. Joan Lunzner, project lead at Stevens Community Medical Center. "As practitioners, we'll have some new opportunities to help our patients."
What is PAD?
Peripheral artery disease or PAD is a coronary disease caused by a buildup of fatty deposits in the arteries of the legs. When those arteries are blocked, oxygen can't get from the heart into the muscles in the legs.
As a result, those suffering from PAD will experience leg pain or discomfort when they're walking or doing other physical activities, a symptom called claudication. However, the pain goes away quickly after stopping activity or taking a break.
"The symptoms are quite specific and predictable, and different from other kinds of leg pain," said Treat-Jacobson.
Some people who suffer from the condition will describe walking down the street and needing to stop until the pain eases — they'll wish for a red light or pretend to window shop to hide their pain. One study described PAD as an illness that causes sufferers to "stand still in the street," Treat-Jacobson said.
The risk factors for PAD are similar to those of other coronary diseases — smoking or a history of smoking, diabetes, high blood pressure and high cholesterol. PAD typically affects individuals between between the ages of 65 and 70, and affects around eight million people in the United States.
One of the reasons researchers are focusing on PAD diagnosis and treatment is that the condition can often be an early signal of a more serious coronary incident like a heart attack or stroke.
"A decade or two ago, PAD was thought to be rather benign until it got to its end stage where you had ulcers, pain at rest or were at risk of amputation," added Treat-Jacobson. "What they found out is people were dying of these other cardiovascular events long before the leg problems deteriorated. Once that was discovered, it became clear that PAD is something to be found early and the risk factors treated to prevent those cardiovascular events."
Screening for PAD
If a patient reports experiencing the symptoms of PAD, the condition can be diagnosed relatively simply using a quick, non-invasive test — the ankle-brachial index.
An ABI compares the blood pressure measured in the arm with the blood pressure measured in the ankle using a doppler ultrasound device. A low pressure in the ankle can indicate a narrowing or blockage of the arteries in the leg.
"That simple test shows the patient and provider that something is going on here that needs to be paid attention too," said Treat-Jacobson. "Then you could go on to do other testing to confirm, see how bad it is, see where the blockages are."
As part of the grant, SCMC has received new equipment for trained nursing staff to conduct ABI tests in the clinic. Previously, doctors would need to schedule patients with the x-ray department to get the data for a diagnosis.
"I get an answer right now and the patient gets an answer right now and we can move forward with a diagnosis right at that visit," said Lunzer.
To get the ball rolling, Stevens Community Medical Center has planned a PAD community screening event scheduled for Wednesday, Feb. 10 at SCMC from 9 a.m. to 3 p.m. All members of the community, regardless of their provider, are welcome to set up an appointment at the screening event.
Community members who are 50 years or older that are experiencing leg pain and who have any of the risk factors of PAD — history of smoking, diabetes, high blood pressure, high cholesterol — are encouraged to attend.
At the screening, attendees will be able to have an ABI completed to see if they may have PAD. Because the ABI measures the blood pressure at the ankle and the arm, participants will need to remove their shoes and socks and are encouraged to wear a short-sleeved shirt.
Community-based health initiatives
Grant support for the PAD Prairie Initiative won't stop after the screening event — it will also provide support for ongoing cardiac rehab and community health initiatives.
One of the best ways to treat the symptoms of PAD is through a supervised exercise rehab program.
Since Medicare doesn't currently cover the cost of supervised exercise or exercise rehab for patients with PAD, the grant can be used to help subsidize the cost of those programs to cardiac rehab centers like SCMC for providing that service, said Treat-Jacobson.
How that grant programming will work in Stevens County is still under discussion, said Lunzer. Part of the plan is to train the facility's current cardiac rehab nurses — Pam Heil and Ruth Schmidgall — to also serve as PAD rehab nurses.
Lunzer said she also hopes to follow up with educational programming and other services for community members who come to the screening or have risk factors for PAD.
"We're looking for ways to extend the programming out in the community — hopefully this wellness and awareness will spread out to more people and more people will come in to get this diagnosis," said Lunzer. "It's really going to develop as we go."
You can find out more information about the PAD Prairie Initiative online at http://z.umn.edu/padprairie.
PAD Community Screening information
WHEN | Wednesday, Feb. 10 from 9 a.m. to 3 p.m.
WHERE | Stevens Community Medical Center
WHAT IS PAD? | Peripheral artery disease is a condition that occurs when blood flow to the legs is blocked from buildup for plaque or fatty deposits in the blood vessels of the legs. The most common symptom is pain in the legs while walking.
RISK FACTORS FOR PAD | History of smoking, diabetes, high blood pressure, high cholesterol, 50 years of age or older