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Many people often complain of leg pain that is accompanied by leg swelling, heaviness, cramping, itching, varicose veins, skin discoloration, hair loss, and/or ulceration. Some people will experience pain at rest or pain with activity. Disease states that are responsible for these symptoms are related to disorders of the arteries and veins of the legs. 

Deep Vein Thrombosis

Blood clots in the leg, also called Deep Vein Thrombosis (DVT), can form in the lower leg, thigh or pelvis. DVT is caused by prolonged rest or travel, family history, obesity, pregnancy, blood disorders, and cancer. When clots form they block the flow of blood from the lower extremity back to the heart. This produces leg swelling and heaviness which then leads to leg pain, warmth, and redness. These blood clots can travel from the leg to the lung and cause blood clots trapped in the pulmonary arteries, called a Pulmonary Embolism (PE) producing shortness of breath and chest pain. This can be life threatening and must be treated emergently. Call 911 if you think you may be suffering from a PE. Untreated DVT can also cause post-thrombotic syndrome (PTS) which results when DVT causes long-term damage to the valves in the veins. Symptoms of PTS include pain, swelling, discoloration, scaling of the skin and ulcers. In some cases, PTS can lead to permanent disability. 

Treatment for DVT includes blood thinners and minimally invasive surgery. If medication doesn’t work or symptoms are too severe minimally invasive surgery using advanced medical technology can rapidly remove the blood clot from the veins restoring blood flow, resolve the symptoms, and prevent PE and PTS. The goal of treatment is the rapid relief of symptoms and improvement in the quality of life.

DVT prevention is also critical. The best thing you can do is keep mobile and hydrated during times of rest. Squeezing your calves or flexing your calves and wearing compression stockings can keep blood flow moving. Stay hydrated, make sure you drink at least four 16 oz bottles of water a day. This will keep your blood thin.

Venous Insufficiency

Veins that can no longer return the blood back to the heart are called insufficient. This can be caused by prolonged standing or sitting, previous DVT, family history, and obesity. Veins have one-way valves that direct the flow back to the heart. When these veins become damaged, like from DVT or from prolonged standing, they can no longer direct flow back to the heart, and the blood pools in the feet and ankles resulting in leg pain at rest, leg swelling, heaviness, and varicose veins. When this goes on for too long it can result in skin discoloration, skin thickening and ulcerations. Sometimes small blood clots form in the varicose veins causing inflammation and pain. In some cases, this can lead to permanent disability.

Treatment of Venous Insufficiency is done using compression stockings and minimally invasive techniques using a small catheter to close the diseased vein by using heat or glue. This a rapid and efficient treatment that will reroute blood from your legs to your heart using healthy veins significantly improving your symptoms. 

Venous Insufficiency prevention is critical. The best thing you can do is wear compression stockings if you are in jobs that require prolonged standing, prolonged sitting, intense labor, or lifting heavyweight. Take a rest when you can!

Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) occurs when the arteries become blocked or narrowed and can no longer deliver their cargo efficiently. Arteries of the leg are the delivery system of nutrients and blood to bone, muscle, and skin. Reduced blood flow can result in leg pain with activity, hair loss, loss of muscle tone, skin discoloration, and ulcerations. PAD is caused by plaque build-up in the artery the narrows the space within the artery and can eventually lead to artery blockage. This plaque buildup can be caused by genetics, family history, diet, smoking, chronic renal disease, coronary artery disease, stroke, and diabetes. 

Claudication is a common presenting symptom of PAD. Claudication is described as pain with walking. If you develop muscle cramps and pain after walking short distances it can be a sign of arterial narrowing. Occasionally, the arteries can be blocked rapidly and cause quick onset leg pain that is unbearable called Acute Limb Ischemia. This should be treated emergently. If your leg has suddenly turned blue or pale in color, has lost a pulse, feels numb or overly sensitive call 911. 

Critical Limb Ischemia is commonly seen in people that have chronic kidney disease, diabetes, and who smoke cigarettes. The common symptoms are pain at rest, muscle wasting, and ulcerations.

Treatment of PAD is done using medication and minimally invasive surgery with catheters to restore the normal size of the artery to return normal blood flow to the leg. Medication is used to thin the blood to prevent blood clots and reduce plaque build-up which usually are lifelong medications. In some cases, untreated PAD can lead to permanent disability.

PAD prevention is also very critical. Maintaining a healthy active lifestyle is the best choice you can make. Activity and exercise promote arterial health. A heart-healthy diet or caloric restricted diet is important to keep weight off and prevent plaque build-up. You should not smoke and if you do, I encourage you to quit. There are many support groups and medications that can help you fight the urge and be smoke-free.

Vascular Interventional Radiology is the future.

At Great Lakes Medical Imaging, our Vascular Interventional Radiologists are here for you now. They are highly trained physicians that have expertise in the latest methods to manage and treat arterial and venous disease using x-ray technology and minimally invasive surgery with small catheters – thin tubes that are threaded through the diseased vessel to reduce your symptoms and improve your quality of life. Call Dr. Chohan and his team of Vascular Interventional Radiologists at 716-836-4646 to speak more about leg pain and if there is a treatment option for you!

Great Lakes Medical Imaging www.greatlakesmedicalimaging.com

Urinary Tract Infections (UTIs) account for roughly 8.1 million annual doctor visits, and about 60 percent of women will experience a UTI in their lifetime. To understand why UTIs occur, it is helpful to understand the urinary tract, which makes and stores urine in the kidneys, and travels down the ureters to the bladder where it is stored until emptied. Urine is emptied through the urethra, a tube that connects the bladder to the skin. The opening of the urethra is at the end of the vaginal opening in females. Normal urine doesn’t have bacteria in it, but bacteria can get into urine through the urethra.

UTI symptoms include a need to urinate more often, and burning or pain when urinating. It can also cause a strong urge to urinate even when you don't have much urine in your bladder. The urine may also smell bad and appear cloudy or even bloody. It is important to call your health provider if you experience any of these symptoms. Noticing any blood in the urine may indicate a sign of something more serious, making the need to call your health provider more urgent.

One of the primary causes of UTIs in women is that they have shorter urethra than men. However, some women are more prone to UTIs compared to others. Women who are going through menopause typically have a higher chance of getting a UTI due to a reduction in their estrogen levels. Some women are genetically predisposed to UTIs. Sexual intercourse can trigger and also increase the frequency of UTIs, as can the use of diaphragms and condoms with spermicidal foam.

Sometimes the cause of UTIs is an abnormality in the urinary tract. Such abnormalities include diverticula that harbor bacteria in the bladder or urethra or blockages, such as an enlarged bladder, that prevents the body from completely draining urine from the bladder. Individuals with diabetes are also at a higher risk, as their bodies don’t fight germs off as well.

To decrease the risk of UTI, it is helpful to drink plenty of fluids, refrain from putting off urinating, or not fully emptying the bladder due to being in a rush to urinate. Drinking cranberry juice or taking over-the-counter cranberry supplements can also help prevent UTIs.

Fortunately, most women have simple UTIs that can be successfully treated with a short course of antibiotics, after which symptoms are alleviated. Postmenopausal women who experience UTIs can often be helped with topical hormone replacement with estrogen. When a UTI is complicated, a longer course of antibiotics is required, sometimes intravenously at a hospital. Women who get UTIs often should see their health provider for testing and treatment.

Armen Kirakosyan, MD, FACOG, FMPRS, FRCSC, FACS is a board-certified urogynecologist at General Physician, PC. He is experienced in treating a wide range of issues, from the most basic to complex surgeries. Learn more. To make an appointment with Dr. Kirakosyan, click here or call 716-656-4077.

Living in Western New York, you can’t avoid cold, snow, and ice during the winter, but you can prevent serious winter-related injuries. In an earlier blog post, Dr. Riegel discussed heart attack risks. This week, Dr. Falcone, an orthopedic surgeon, offers tips for protecting your bones, joints, ligaments, tendons, and muscles.Thousands of people every year suffer from preventable injuries during the winter months. To protect yourself, observe some basic safety tips to prevent yourself from being one of them.

Protect Your Body, Inside and Out

Cold temperatures make muscles, tendons, and ligaments more prone to injury, so you’ll want to mitigate the risks of spending time outside by:

• Keeping your body warm. Wear appropriate outerwear and layer your clothing to accommodate your body’s constantly changing temperature. Your layers should be light, loose, water-resistant, and wind-resistant.
• Stretching. Warm up your muscles before shoveling, putting up or taking down holiday lights, or performing other outdoor home-care tasks.
• Staying Drink enough water! It’s natural to worry about dehydration in the heat of summer, but in winter, don’t forget our bodies are often working harder to move under extra or heavier clothing, breathing harder from exertion, and sweating when we’re inside over-heated buildings. If your body becomes dehydrated, lactic acid builds up in your muscles, which can cause cramps and bodily strain—greatly increasing the chance of falling and other injuries. Proper hydration helps keep your muscles and ligaments healthy, and it even helps with pain relief and healing.
• Wiping your shoes thoroughly when you enter a building. Snow and ice build up in the soles and can cause you to slip when you step onto a smooth, hard floor. 

Beware of the Biggest Problem

Falling or slipping on icy outdoor surfaces, of course, is the biggest issue we face in the winter months. Both can cause broken bones, wrenched backs, sprained joints, or head injuries. We all take walking for granted, but if you try to walk in the winter like you do in the summer, you’re putting yourself at risk.Two things are essential to injury prevention: wearing boots or shoes designed for maximum safety on ice and snow and changing the way you walk. Slip-resistant footwear is key. So is taking shorter steps with slightly bent knees and taking things slow—try not to rush or run. If you have the choice between walking on potentially icy pavement or snowy grass, choose the grass. That way, if you fall, you’re less likely to be hurt. And, when you’re out and about, use handrails whenever possible, treat every walkway as though it has black ice, and keep your hands out of your pockets – you may need your arms for balance or to catch yourself. In fact, if you have to navigate black ice, walk like a penguin: widen your stance, spread your arms, and do your best to balance.

And if you do fall? Bend your elbows and knees to help your arms and legs absorb the impact, and be mindful of how you get up.

Prepare to Drive Differently

Winter driving can be harmful to your body, including preparations. Scraping ice and snow off your car—be sure to clear both windshields!—can bring about damage to joints, tissue, and muscles. Shoveling, with all the lifting, twisting, and throwing it requires, can cause muscle strains, sprains, and soft tissue injuries. Try pushing the snow away instead of lifting it onto your shovel. If you lift it, protect your back by keeping a slight bend in your knees. And listen to your body: if something is starting to hurt, take a break. Finally, pay attention to severe weather warnings. If you don’t have to be out on the roads when conditions are snowy or icy, don’t go anywhere. But if you do, take proper precautions to avoid abrupt stops, skids, and collisions—which can cause concussions, whiplash, back injuries and broken bones.

One final note: if you have any pre-existing orthopedic conditions, including and especially joint implants or any kind of surgical reconstruction, be sure you talk to your physician about any extra precautions you might have to take in the winter weather. We want everyone to enjoy the great outdoors this winter – safely!