Selasa, 11 November 2014

Peripheral Artery Disease

Many medical conditions affect the network of arteries and veins that carry blood to and from the body’s tissue. Such damage is generally referred to as peripheral artery disease (PAD).

Compromised peripheral blood supply leads to tissue ischemia (lack of circulation) and tissue hypoxia (lack of oxygen). As the result of those effects, there is a change in microcirculation and occurrence of edema (swelling). Edema further compresses capillaries and aggravates ischemia and loss of sensitivity (neuropathy).

Warning signs of PAD are pain, swelling, skin discoloration, itching and decreased hair. Frequent cold hands and feet, as well as dry flaky skin are usual signs of poor circulation. In such cases little cuts or wounds may not be able to heal in a “normal” period and may turn into “chronic”, frequently complicated with infections and finally to the gangrene of the limb. If left untreated, gangrene progresses and the amputation of extremity (partial or complete) are unavoidable.

Hyperbaric oxygen therapy is effective in correcting ischemia and hypoxia caused by PAD, promoting microcirculation, reducing swelling and inflammation and directly fighting infection to speed up wound healing.

 Benefit of hyperbaric oxygen therapy 

  •  improves tissue oxygenation and elimination of toxic substances, that were accumulated due to  poor circulation and hypoxia 
  •  relieves pain 
  •  reduces swelling and inflammation
  •  improves sensitivity and reduces numbness 
  •  triggers new capillary formation for improved local circulation and blood supply 
  •  improves quality of blood and prevents blood clotting and chances of thrombosis 
  •  enhances immune system response and increases the effect of antibiotics 
  •  prevents/reduces infection rate 
  •  reduces incidence of ulcer development

 HBO is beneficial 

  • stop further tissue damage 
  • provide optimal oxygen environment for all phases of wound closure
  • promote new tissue growth and fast wound closure
  • prevent excessive scar formation (caused by slow healing)
  • prepare a host for skin grafting and increase chances of graft survival
  • prevent/stop infection 

Treatment protocol for hyperbaric oxygen therapy

Medical hyperbaric oxygen sessions are two hours long at depth of 2.4 to 2.8 ATA with 60‐90 minutes of pure oxygen while under pressure. HBO sessions are given in chambers.  Number of HBO sessions needed depend on the seriousness of the condition and can be determined upon evaluation of the microcirculation.    

                          Sidestepping Peripheral Artery Disease

Julian Whitaker, MD

 Do you have pain and cramping in your calf or thigh muscles after walking or climbing stairs? Does one leg or foot feel numb, weak, or colder than the other? Have you experienced hair loss or slow‐healing sores in your lower extremities? These are the signs and symptoms of peripheral artery disease (PAD), a common and potentially serious condition that affects one in 20 middle‐aged Americans and one in five people over age 70. PAD is to the legs what coronary artery disease is to the heart. Diseased, narrowed arteries (atherosclerosis) compromise blood supply to the lower extremities, and the pain that comes with exercise, called intermittent claudication, is essentially angina of the legs.  

Conventional physicians treat PAD like they treat coronary artery disease—with drugs, angioplasty, stents, and bypass of blockages in the arteries of the legs. But as with heart disease, this approach is foolhardy and shortsighted. It may relieve symptoms, but it does not tackle the underlying problem. It’s simply an invasive, expensive, temporary fix. Atherosclerosis is a systemic disorder, and it needs to be treated as such by addressing underlying risk factors, making lifestyle changes, improving nutritional status, and, if necessary, using noninvasive treatments to improve circulation and arterial health.

                                         Change Your Lifestyle, Change Your Life 

The most significant risk factors for PAD are the same as for other cardiovascular diseases: diabetes, smoking, hypertension, and obesity, as well as nutritional deficiencies and elevations in blood lipids, C‐reactive protein, and homocysteine. Therefore, the first thing you need to do is to get a handle on these conditions. Begin by cleaning up your diet and adopting an all‐around healthy lifestyle.

You should also try to exercise. One of the most troubling aspects of PAD is its toll on physical activity. Intermittent claudication can make walking across the street a major ordeal and climbing stairs a nightmare. But according to a 2009 study published in JAMA, increasing your activity level is exactly what you should be doing.

Researchers from Northwestern University enrolled 156 patients who had PAD, with or without leg pain, in a six‐month, three‐times‐a‐week program of supervised treadmill or resistance exercise. When participants were retested at the study’s conclusion, both groups—but particularly the treadmill exercisers—were able to walk longer distances. They also reported better quality of life.

                                                 Drugs Versus Supplements

 If you have symptomatic PAD, your greatest concern is likely the pain and debility caused by intermittent claudication. For this condition, doctors often prescribe Pletal (cilostazol), a drug that increases blood flow to the limbs. Pletal is not a very effective medication. Plus, it has a number of frightening side effects, including a black‐box label warning that it “decreases survival” in patients with congestive heart failure. Another option is Trental (pentoxifylline), but this drug has no long‐lasting effects.

Medications aimed at symptom control are not the best therapies for PAD. Like heart disease and diabetes, successful treatment of this condition requires an ongoing lifestyle program of diet, exercise, and nutritional supplements. One supplement with proven benefits is Ginkgo biloba, an herb with mild blood‐thinning effects that is a popular PAD therapy in Europe. In a recent German study, researchers gave patients with moderate PAD and intermittent claudication 40 mg ginkgo supplements three times a day for 24 weeks, and their walking performance significantly increased.

Another is propionyl‐L‐carnitine. In a year‐long clinical trial, this supplement improved walking distance in patients with relatively severe PAD by 44 percent compared to placebo. Inositol hexaniacinate, a form of vitamin B3 and no‐flush cousin of niacin, has also been shown to extend the distance PAD sufferers can walk prior to the onset of debilitating pain.

                                        More Supplements That Make a Difference 

PAD involves much more than pain in the legs. Poor blood flow to the extremities increases the risk of blood clots, which can lodge in narrowed arteries and cause serious complications. To minimize this danger, we give our patients Circulate, a product that contains Seanol, a seaweed extract, and nattokinase, an enzyme present in natto, a Japanese fermented food. Both of these unique compounds help normalize fibrinogen and other clotting factors in the blood. This not only reduces risk of potentially deadly blood clots but also improves overall circulation.

Patients benefit from vitamin K2 as well. K2 is active in the bones and soft tissues, escorting calcium into the bones where it belongs and out of the arteries and other soft tissues. When you have deficiencies in vitamin K2, calcium can build up in and contribute to hardening of the arteries. Dutch researchers have discovered very strong links between vitamin K intake, arterial calcification, and cardiovascular death.

We also recommend fish oil for its anti‐inflammatory, anti‐platelet, and cardioprotective effects, as well as an antioxidant‐rich multivitamin and mineral supplement. Deficiencies of vitamins A, C, and E increase risk of PAD, and a low blood level of vitamin D was shown to raise risk by 80 percent.

                                             The Dynamic Duo

 At Whitaker Wellness, we treat patients who have severe PAD with two additional noninvasive therapies that not only relieve the pain of intermittent claudication but also provide enduring improvements in blood flow throughout the body.

 Enhanced external counterpulsation (EECP) is a mechanical therapy that rhythmically squeezes the lower extremities, forcing blood up through the legs and dramatically enhancing circulation. EECP works on multiple levels to heal diseased blood vessels. It reduces stiffness of the arteries and makes them more flexible and responsive, boosts the release of nitric oxide (a potent vasodilator), and stimulates the growth of new vessels around blocked arteries. Consequently, this therapy produces improvements in chest and leg pain, increases in exercise capacity, and often results in reduction of medications.

Although EECP has been studied primarily as a treatment for coronary artery disease, it benefits the entire vascular system. Debra Braverman, MD, author of Heal Your Heart With EECP, reports that PAD patients who are treated with EECP have predictable improvements in circulation in the legs that allow them to walk longer before pain sets in. Although EECP may not be suitable for some patients with extremely severe disease, Dr. Braverman predicts that it will become a routine treatment for PAD in the future.

We often use EECP in conjunction with hyperbaric oxygen therapy (HBOT). Italian researchers found that when patients with various stages of PAD, ranging from mild pain on walking to severe pain at rest, breathed 100 percent oxygen in a pressurized environment, 70 percent had reductions in clinical symptoms. Ankle‐brachial index, a popular test used to diagnose PAD, also improved in nearly half of these patients.

A Silent Stalker 

PAD can fester for years without symptoms—and when they do appear, they’re all too often chalked up to aging or fatigue. Please understand that PAD does not exist in a vacuum. Atherosclerosis is not localized to the legs or the heart. It’s a systemic disorder, and problems in one area are usually indicative of problems elsewhere.

If you are in your 50s, 60s, or 70s, my best advice to you is to take the recommendations offered in this article seriously, make the necessary lifestyle changes, and start using appropriate nutritional supplements—even if you haven’t been diagnosed with PAD or cardiovascular disease. This comprehensive approach is the only way to ensure that “every day, in every way, you will get better and better.”


Therapeutic daily doses of the supplements recommended for intermittent claudication are ginkgo extract 120 mg, propionyl‐L‐carnitine (or regular L‐carnitine) 2,000 mg, and inositol hexaniacinate 4,000 mg, taken in divided doses. I suggest trying these one at a time and giving each a two‐ or three‐month trial until you find what works for you.

Doses of the other recommendations are as follows: nattokinase 2,000 FU (fibrin units), vitamin K2 (the MK‐7 form) 100–150 mg, vitamin A 20,000 IU (mostly as beta‐carotene), vitamin C 1,000 mg, vitamin E 400 IU, fish oil 2,000 mg of EPA/DHA, and aspirin 81 mg. Do not take ginkgo, nattokinase, or vitamin K if you are on Coumadin (warfarin).

To figure out how much vitamin D you need, test your blood level and take enough to increase it to 50–80 ng/mL. Most of my patients require 5,000 IU daily to achieve optimal blood levels. If your homocysteine is high, consider increasing your daily intake of folic acid to 2,000–5,000 mg and your B12 to 1,000–2,000 mg, retest your level, and adjust your dosages accordingly.  

sumber ,ditayangkan ulang oleh dr.erick supondha (hyperbaric &diving medicine consultant) dokter ahli hiperbarik dan kesehatan penyelaman , jakarta indonesia 021 99070050