Questions on PAD & Burning Mouth

Dear Dr. Spence,
I have recently seen the media advertise about the importance of being screened for PAD. What is this and what should I do?
Signed,
Ami Clogged

Dear Clogged,
PAD, or peripheral artery disease, essentially refers to decreased blood flow to the lower extremities secondary to arteriosclerosis. It is estimated that nearly 20% of those over 70 years of age are afflicted with PAD. Often, PAD coexists with coronary artery disease or cerebrovascular disease. Over five years, 4-8 % will require procedures to improve blood flow and 2-4% will require amputation. Patients who have symptoms (not all do!) will present with pain in the buttocks, thighs or calves that is elicited by exertion and relieved by a period of rest. Progression of the disease may lead to non-healing ulcers of the lower extremities and ultimate gangrene and amputation. The good news is that evaluation is both inexpensive and convenient. Essentially, a ten minute, in-office, non-invasive ABI (ankle-brachial index) will allow for easy assessment of vascular impairment. ABIs are calculated ratios between blood pressures taken in the arms and the legs. Any ratio less than 0.95 is considered abnormal and may require further investigation Management of the disease consists of both conservative and medical therapy. The most obvious risk modification can be achieved through smoking cessation. Patients need to stop smoking! Walking can also dramatically improve symptoms and complication as can stringent control of blood pressure and cholesterol levels. Secondary management consists of anti-platelet agents such as aspirin or plavix that are used to prevent clotting. Studies demonstrate that patients achieve an 18% risk reduction in stroke and heart attack if one of these agents is utilized. The newest drug for treatment of PAD is cilostazol (pletal). Fifty percent of patients suggested that their exercise tolerance/walking distance had improved on pletal; 84% on placebo felt their symptoms had worsened. Given the fact that September was officially PAD Awareness Month, there is no better time to address this issue and advocate more aggressive screening. And yes, we do screen in our office.

Dear Dr. Spence,
My mouth seems to burn and ache constantly. My doctor insists that there are no problems or diseases present. Am I going crazy?
Signed,
Hot Lips

Dear Hot Lips,
Your burning mouth issues are probably secondary to burning tongue/mouth syndrome. I know it sounds made-up and ridiculous, but it is a well known phenomenon in the medical literature that has no known cause. We think it is a variant of a neuropathic pain syndrome, or nerve pain syndrome. Irritation of a nerve often results in pain that is described as burning, shooting or stabbing; sometimes it is simply numbness. Treatment is geared towards decreasing nerve irritability. Options include amitriptyline (elavil), clonazepam (klonopin), capsaicin (hot pepper) and anti-seizure medications (neurontin). I have had some success with lyrica, but I must admit treatment remains frustrating for both patient and physician alike.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.