A Tale of Two Patients and One Diagnosis

Peripheral Arterial Disease occurs when blood flow is cut off or limited to the foot and leg, and results in terrible pain.

They’re on opposite ends of the spectrum. Bill Ivins, 71, of Vacaville, is diabetic with failing kidneys and a history of heart disease
in his family. Ashley Marques, 23, is athletic and active and focused on getting her degree from UC Santa Barbara.

But they both were stopped in their tracks by the same troubling disease: Peripheral Arterial Disease, or PAD. It occurs when blood flow is cut off or limited to the foot and leg, and results in terrible pain.

For Bill Ivins, it was another bump in a pretty bumpy road. The retired pipefitter and foreman from Mare Island Naval Shipyard has wrestled with diabetes, undergone a quadruple heart bypass and struggles with COPD, or Chronic Obstructive Pulmonary Disease, and asbestos exposure.

“I was pretty healthy for the first 50 years of my life,” says Bill, affable and outgoing despite his troubles. “When my leg started hurting, I guess I just assumed it was the diabetes.”

Cardiologist Milind Dhond, M.D., discusses whether surgery would be optimal for Bill Ivins.

A home health nurse suggested he get a medical opinion. After tests, cardiologist Milind Dhond, M.D., medical director of NorthBay’s Peripheral Vascular Program, could see blockages in both legs. But it was the right leg that needed quick attention.

Ulcerations weren’t healing, and he knew if the situation wasn’t addressed, Bill could lose his leg. After a two-hour procedure in the cardiac catheterization lab, blood flow was restored. “We had to use balloons to open up his arteries, but it was successful,” says Dr. Dhond.

The image (left) is an angiogram of Ashley Marques’ leg, behind the knee, showing limited blood flow, and (at right) blood flow after the repair.

It wasn’t such a clear-cut case for Ashley. She first visited her university’s urgent care program to figure out what was going on with her right leg and foot.

“I was told I probably had Raynaud’s disease (recurring numbness in extremities) and that I should go home and put my foot in hot water. That it would just be a painful thing I’d have to live with.”

And so she tried, for some time, to live with it. The pain started with numbness in her toes, and later spread to her foot. By the time winter break rolled around, the pain was excruciating and radiating up her leg.

She had come to the Bay Area to visit family, and was at her aunt’s home in Vacaville right before Christmas when the pain was so bad, she couldn’t sleep. “I just cried all night. My dad said, ‘We’re going to the Emergency Room first thing in the morning.’”

At VacaValley Hospital’s Emergency Department, the first thought was also Raynaud’s disease, but extensive tests were confounding: they revealed little blood flow below Ashley’s knee. At that point, she was transferred to NorthBay Medical Center and into the care of Seph Naficy, M.D., a cardiothoracic and vascular surgeon with the NorthBay Heart & Vascular Center.

An attempt by Dr. Naficy to open her blocked artery in the cardiac catheterization lab proved unsuccessful, and that left surgery as the only option.

On Christmas Eve, Ashley was taken to the operating room at NorthBay Medical Center where Dr. Naficy solved the mystery. Ashley’s knee artery was compressed by muscle tendons, a situation she was born with and that had been developing through the years. As a result, the blood vessel behind her knee was damaged and filled with clot.

Dr. Naficy removed the clot, and reconstructed the damaged vessel. Healing, however, took some time. The sociology major decided to take a quarter off from school. For the first few weeks, she couldn’t put any weight on her foot, but she gradually regained her strength, mobility and flexibility.

“There had been no blood flow into my foot for so long, that it took time to bring it back to normal,” says Ashley, who now walks without so much as a limp. “I’m just lucky I get to keep my leg. I think about it all the time.”

Bill Ivins, too, is glad Dr. Dhond and the team in the cath lab and at the Same Day Center were able to help him save his leg. “Everybody was so friendly and helpful, and I really want to let them know how much I appreciated the compassionate care,” he says.

He might consider the same procedure for his right leg, but for now he’s taking a conservative approach at Dr. Dhond’s direction.

“It’s been a tough time on me and my family, but I know NorthBay’s team is here to help.”

Just the Facts – What is PAD?

While Peripheral Arterial Disease, or PAD, is most common in men over 50, Ashley Marques, 23, is proof that it can also occur both in women and younger people.

Symptoms of the disease include pain, aches, fatigue, and burning or discomfort in the muscles in feet, calves or thighs, especially during or right after exercise.

The disease is caused when arteries are hardened with a fatty buildup, or plaque, which results in decreased blood flow. That can lead to damage of nerves and tissues.

In severe cases, the patient might experience cramps or pain at night, a tingling in the feet or toes, and ulcers that do not heal. In some cases, a patient can improve their condition with exercise, weight loss (if the patient is overweight) and smoking cessation. It’s important to control cholesterol and blood pressure. Medication can also help.

In more serious cases, ballooning or placement of a stent in an artery during a catheterization lab procedure can correct the problem. And in extreme cases, such as Ashley’s, surgery might be necessary.

If you are experiencing the symptoms and suspect you might have PAD, contact your doctor for an exam.

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