It may go something like; 'You know I always have poor circulation in my feet'.

Well here is what you need to know. Poor circulation is not normal. Poor circulation may be a sign of a more serious condition called peripheral arterial disease.

What are some factors that put a person at risk of developing peripheral arterial disease?

Cigarette smoking. In one study people who smoked had an increased risk of:

    * Type 2 diabetes especially in those over the age of 50
    * High cholesterol levels
    * High Blood Pressure (Hypertension)
    * People over the age of 70
    * If you have had blocked arteries elsewhere. This is calledatherosclerosis. Examples would be angina (chest pains) or a heart attack, strokes or kidney disease.

You may notice that a lot of the above factors, except cigarette smoking, type 2 diabetics are at risk of developing anyway.

Now do you see why poor circulation is something that cannot be ignored?

Peripheral arterial disease is the leading cause of non-traumatic amputations in the United States.

I have met some myths in people with type 2 diabetes, especially African-Americans. One of these myths was that if you are diagnosed with diabetes, that eventually your legs would get cut off.

In fact they usually could tell me stories of friends or relatives that this had happened to.

A myth does not have to become self-fulfilling prophecy.

I want to dispel this myth. I want to prove that people living with diabetes do not have to give up on life. They don't have to wait for their legs to get amputated. End up on dialysis, suffer a heart attack or stroke.

In order to change a statistic, we need to increase our awareness.

How do you know if you have peripheral arterial disease?

A common complaint that people have is claudication. Claudication causes pain and/or cramps in the legs. They may start to walk. Have to stop because of the pain. And then start to walk again. Then they have to stop again.

As peripheral arterial disease gets worse, the pain in the legs may occur even when at rest. A lot of people may describe this as cramps in the legs, or a 'Charlie horse'. Peripheral arterial disease may cause less hair on the legs. The toenails may become brittle and break off easily. The skin may also get darker in color and shiny.

How is peripheral arterial disease diagnosed?

It is straightforward to diagnose someone with peripheral arterial disease when they already come in complaining of 'poor circulation'. So the person who complains of pain while walking that stops them in their tracks or even pain at rest, most likely has peripheral artery disease.

Your doctor most likely will refer you to a vascular specialist.

Here are some tests that may be done:

Ankle-brachial index (ABI)

This is a test that measures the resting blood pressure at the ankle compared to the blood pressure in the arm. Sometimes the test may be normal. So the doctor may have them exercise by walking on a treadmill. Or by taking a brisk walk outside. The normal value for the ABI is between 0.9-1.3.

Segmental Blood Pressure Testing

In this test, the blood pressure is taken at different levels of the leg. For instance the thigh, the calf, and the ankle. The readings are then compared to decide where the blockage is.

Imaging Tests

There are different imaging tests. Ultrasound, CT angiograms and Magnetic resonance angiograms are all examples of imaging studies that can be done. The vascular disease specialist decides what test gets done.

If the symptoms get worse, then the specialist may need to order a more detailed invasive test called an arteriogram. This will help map out exactly where the blockage is. At times surgery may even be needed.

How can you prevent peripheral arterial disease?

You can reduce your risks of developing peripheral arterial disease by making adjustments in your lifestyle. Also follow the medical treatment plan that your doctor recommends.

It is very important to make sure that you follow up with your doctor regularly.

So if you are a person living with type 2 diabetes and you smoke, quit smoking.

Get your cholesterol checked and if it is high, then make sure that it is treated. Lowering the cholesterol to less than 100 mg/dL will help to reduce the symptoms of claudication.

If you have high blood pressure, take your medications. And make sure that you keep your blood pressure under 130/80 mm hg.

If you have had a heart attack, stroke or have angina make sure that you are being properly treated for these conditions. They increase your risk for peripheral artery disease.

Think of the circulatory system in the body like the plumbing in your house.

If the sink gets clogged up one day, there's a fair chance that the toilet may get clogged another day. This is because as your house gets older the plumbing system will need to be unclogged from time to time.

The same thing with cholesterol build up (called atherosclerosis) in the circulatory system of the body.

Medications:

Your doctor or the vascular specialist may also start you on medications for peripheral artery disease.

Always remember that you can prevent peripheral arterial disease. And even if you do get symptoms, the important thing is to treat it early.

Let's reduce amputations from peripheral arterial disease. So remember if you have 'poor circulation' please schedule an appointment to see a healthcare provider immediately.

By Eno A. Nsima-Obot, MD