According to a study published in 2015, the number of heart attacks recorded during the coldest months of the year was 31% higher compared with the warmest months. Numbers were higher in those with underlying cardiac conditions or age greater than 65 and were highest on days where the temperature was below freezing.  Another study reported a 19% increased risk of stroke during winter months related to the development of atrial fibrillation which is an irregular heart rhythm.

Why is our risk higher in winter?

Well, the effects of cold temperature on the body result in vasoconstriction, that is, the blood vessels clamp down which results in increased heart rates and blood pressure. The laws of supply and demand are in play. The longer the exposure, the higher the risk. Add to this if there is any overexertion such as shoveling snow or trying to walk faster in windy or snowy weather, or if we are not dressed warm enough. Another important factor is the higher incidence of flu and respiratory infections in colder months, particularly this year with the coronavirus pandemic.

What can we all do to lower our risk?

First, we should reduce our time of exposure as much as possible. Dress appropriately and layer clothing, but don’t over layer as this can lead to overheating which also can be harmful. Avoid shoveling snow if you have any underlying cardiac condition or other medical problems. Take breaks as appropriate if digging out your car from the snow. Absolutely get the flu shot. Soon the COVID vaccine will also be rolling out. Wash your hands and wear masks to reduce our infection risk. Refill your prescriptions on time, don’t let them run out because you didn’t want to leave the house. 

Know the Signs.

Finally, we should all know the potential warning signs of a heart attack - which could include chest pain or pressure, discomfort in the arms, upper back or jaw, often accompanied by nausea, sweating or shortness of breath. If any of these, seek medical attention immediately.

Let’s all stay warm and healthy this winter!

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

Key points:

• Wear a mask. 
• Stay in your homegroup.
• Stay six feet away from others.
• If you get sick, isolate at home. 
  Stay in touch with your doctor.
• If you are exposed to COVID-19, quarantine. 
• If you have the virus, you can still infect others. 
  Even if you feel fine.
• You are not alone. Help is available. 

If you get sick:  

The most common symptoms of COVID-19 are: 

• Runny Nose
• Congestion
• Fever
• Cough
• Headache
• Fatigue
• Muscle or Body Aches
• Loss of Taste or Smell
• Sore Throat
• Nausea
• Diarrhea

Stay home except to get medical care. Most people with COVID-19 have mild illness. 
Most people recover without medical care. 

Go to the emergency department if you have serious symptoms:

• Trouble Breathing
• Pain or Pressure in Chest
• New Confusion
• Inability to Wake Up or Inability to Stay Awake
• Blue-Colored Lips or Face

Call 911. Notify the operator that you or the other person may have COVID-19. This list does not include all possible serious symptoms. Call your medical provider for symptoms that are concerning. 

If the symptoms are not serious, call your physician. Do not go there without calling. If it’s an emergency, call 911. Tell them your symptoms.  

If you do not have a primary care provider (PCP):

• The Erie County health department’s website has a list of PCPs taking new patients:https://www2.erie.gov/health/sites/www2.erie.gov.health/files/uploads/pdfs/FQHCPrimaryCareEC.pdf
• For other counties, contact your local health department or medical society, or your insurance company.

Take care of yourself. Rest, eat well, stay warm, and drink plenty of water. Talk to your doctor about over-the-counter medications. 

Monitor your symptoms. Get care immediately if you are having serious symptoms. 

Stay in touch with your doctor. Please do not call the health department with questions about your care. 

        

If you are sick or have tested positive for COVID-19, you should ISOLATE:

• For 10 days after your test or after the beginning of symptoms, avoid contact with other members of your household and pets. Stay in a separate room. Sleep in a separate room. Use a separate bathroom, if possible. Do not share personal items, like towels or utensils. Do not go anywhere, including school or work. Wear a mask when around others. 
• Tell your household and close contacts to quarantine (see below).
• Wash your hands frequently with soap and running water for at least 20 seconds.
• Clean and disinfect frequently touched surfaces and objects (for example: tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks). Include the bathroom if sharing with others. 
• Cover your cough or sneezes with a tissue and throw it away. Wash your hands with soap and running water after touching the tissue. If you do not have a tissue, cough or sneeze into your elbow, not your hands.
• If you must leave isolation, wear a mask, stay 6 feet apart from others, wash your hands frequently, and clean all touched surfaces.
• Even if you do not feel sick, you can spread COVID-19 to others. Protect everyone as though they could become seriously ill.
• Information from the CDC on isolation is at: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/isolation.html

If you are not sick but have to QUARANTINE: 

• Stay home for 14 days after your last contact a person with COVID-19. Do not go to work or to school, and do not run errands or visit with friends. 
• Watch for fever (100.4◦F), cough, shortness of breath, or other symptoms of COVID-19. If any of these occur, notify your physician. 
• If possible, stay away from others in your home, especially people who are at high risk.
• Consider getting a COVID-19 diagnostic test 5 to 7 days after the last exposure.
• People who are unable to safely isolate or quarantine should call their doctor, or for Erie County residents, call (716) 858-2929. 

If you were tested for COVID-19:

• If you have symptoms, stay home. 
• If you were in contact with someone with COVID-19, stay home.
• Otherwise, wear a mask, stay six feet from others, and stay in your homegroup. 
• If you were tested for a procedure and you have no symptoms, you do not need to stay home.

When the test results come, discuss them with your doctor.

If your test is positive...

A government contact tracer will call you.

Notify people you’ve been in contact with. Tell them to quarantine and to call their doctor. Tell them to consider getting a COVID-19 test. 

If you have symptoms stay home until:

• You feel better.
• It’s been 10 days since you got sick. 
• You had no fever for one day.
• You haven’t taken fever medicine for 24 hours.

If you do not have symptoms:

• Stay home for 10 days after the test.

If your test is negative...

And you were in contact with someone with COVID-19:

• You could still have COVID-19.
• Stay home for 14 days after you saw the person. 

And you have symptoms: 

Talk to your doctor. While you have symptoms, stay away from work and school. Stay away from other public places. Consider getting another test.

And you do not have symptoms, protect yourself like always: 

• Keep to your homegroup.
• Stay six feet away from others.
• Wear a mask.

If you do not have enough food, or you need health insurance, legal help or anything else:

• There is a list of community resources on the Erie County health department’s website:https://www2.erie.gov/health/coronavirus
• If you are in isolation or quarantine and need help with basic needs, call 2-1-1(www.211wny.org) 
  or the Erie County COVID-19 Information Line at 858.2929.

If you want or need a test: 

• Call your doctor. 
• The Erie County health department has a list of sites in Erie County: https://erie.gov/covidtestsites
• New York State also has a list: https://coronavirus.health.ny.gov/find-test-site-near-you

If you want more information, call your doctor, the county, or the state: 

• Erie County Department of Health COVID-19 Information Line: 858.2929; 
  Foreign language interpreting available (open 8:00 am - 8:00 pm M-F and 8:00 am - 12:00 pm Sat-Sun)
• NYSDOH COVID-19 Information Line: 888.364.3065; Ask a Question Online at NYSDOH COVID-19 Website

You can find answers to Frequently Asked Questions about COVID-19 at: 

• Erie County Department of Health: https://www2.erie.gov/health/index.php?q=frequently-asked-questions-and-answers-about-covid-19-coronavirus
• New York State: https://coronavirus.health.ny.gov/home
• S. Centers for Disease Control and Prevention: https://www.cdc.gov/coronavirus/2019-nCoV/index.html