By Alexander Germanis
One of the worst things in life is suspecting something might be wrong, but not knowing if something is wrong. Not knowing fosters anxiety and stress, which can make any existing problem even worse.
When it comes to one’s health, such as with arterial and venous problems, not knowing what’s wrong can become so detrimental, it can lead to worse health problems, including loss of limb and even loss of life.
At Cardiac Thoracic Endovascular Therapies (CTET), a Heartland Vascular Care Center in Peoria, they are dedicated to not only helping people with arterial and venous diseases, but they are also determined to give people the power of knowing.
Knowing the Path
New to the team at CTET is interventional radiologist Andrew Mullins, DO. Long before he joined the team there, however, Dr. Mullins already knew the path he was destined to walk while still at the tender age of 6. From the moment he watched footage from an open-heart surgery on PBS, he knew he wanted to be a doctor.
His path through medicine was not an average one as it coincided with a career in the United States Navy. With a medical degree from Kirksville College of Osteopathic Medicine and a surgical internship at the National Naval Medical Center in Bethesda, Maryland, Dr. Mullins then served for two years as a General Medical Officer with Special Boat Team-22. Then deploying to Kandahar, Afghanistan during Operation: Enduring Freedom, he was the only interventional radiologist.
After 17 years of faithful service and earning the rank of commander, Dr. Mullins left the Navy to pursue his private practice in Pennsylvania before finally moving to Illinois. Although his environment may have changed, he still carries that dedication to seeing a mission through.
CTET colleague Dr. James Williams can personally attest to Dr. Mullins’ skills and attitude, particularly as he has also been one of Dr. Mullins’ patients. “Dr. Mullins comes to us with a wealth of experience in virtually every vascular field, making him an invaluable addition to our team,” shares Dr. Williams. “His many years of expertise in endovascular procedures and venous diseases have already proven to be an asset to our practice. Beyond these exceptional skills, Dr. Mullins possesses a delightful personality that makes him a pleasure to work with.”
Knowing the Enemy
Not one to talk much about himself, Dr. Mullins instead focuses on how he can help his patients and his fellow physicians. A significant way in which he does that is by fostering an environment of learning about the enemies they’re battling. Peripheral arterial disease (PAD) is one such enemy that needs to be better understood in order to combat it.
Peripheral arterial disease is characterized by the narrowing or blockage of arteries in the pelvis and legs, due to the buildup of plaque and calcium in the arteries, which in turn reduces blood flow to the legs and feet.
“The decreased blood flow means that the muscles and tissues cannot get enough oxygen, and this results in pain, wounds—which usually begin in the toes—and ultimately can lead to amputation,” warns Dr. Mullins. “Symptoms of PAD include fatigue, discomfort, and cramping in the buttocks and legs, which is referred to as claudication.”
Although these symptoms occur only while walking and dissipate with rest, if left untreated PAD can lead to critical limb-threatening ischemia (CLTI). With CLTI, the pain continues even at rest and there is the potential for the development of ulcers and gangrene of the toes and feet, leading to amputation.
Untreated or undertreated PAD is the leading cause of lower extremity amputations, which are particularly taxing on the body of older patients or those with diabetes. Five years after an amputation, the mortality rate ranges from 40 to 70 percent.
“Chronic venous disease includes both superficial and deep venous insufficiency and post thrombotic syndrome (PTS),” Dr. Mullins adds. PTS results from damage to valves within the veins caused by previous bold clots to the legs. These valves are meant to prevent blood from flowing backward towards the feet. “When this happens, the pressure in the veins in the lower legs increases and causes symptoms.”
Symptoms include leg swelling, tiredness, aching of the legs, discoloration and thickening of the skin around the lower legs and ankles, varicose veins, and potentially even skin wounds involving the lower legs and feet.
“Many patients with severe venous disease and venous wounds are likely to end up on disability or have to retire early,” Dr. Mullins warns. “Many patients with severe edema and pain are unable to perform activities that they enjoy or to fully take care of themselves. We provide the most current treatments for both arterial and venous disease and we specialize in treating complex patients who would have no other option than amputation. Reducing amputation rates is a public health problem and we strive to be part of the answer.”
Know the Risks
With vascular disease, as with nearly every other malady, multiple factors can play roles in whether or not someone is at risk.
Those ages 65 and older are at higher risk, particularly if they have heart disease or a history of stroke. “According to the American Heart Association, African Americans are two times more likely to screen positive for PAD than non-Hispanic whites,” Dr. Mullins includes. “And they are also at an increased risk of losing a limb. Patients with poorly controlled type 2 diabetes are up to four times more likely to lose a limb.”
While some factors may be unavoidable, smoking, high cholesterol, and high blood pressure are also major contributing factors, with smokers being three times more likely to develop PAD than non-smokers. Smokers with PAD also report a lower quality of life than those who do not smoke.
Regarding chronic venous disease, females are three times more likely to develop it, with obesity, a family history of varicose veins, and occupations requiring prolonged standing or sitting also being major factors. “A prior history of a blood clot in the leg or deep venous thrombosis is a major risk factor,” the doctor adds. “It is estimated that more than 25 million adults in the United States have varicose veins and more than six million suffer from advanced venous disease.”
Know It When You See It
One of the reasons PAD goes under- or undiagnosed is mainly due to simple awareness of the disease, says Dr. Mullins. “Many patients mistake the symptoms of PAD for moderate conditions such as sciatica,” he points out. “Many patients are also asymptomatic.”
It has been surveyed that only 25 percent of adults with risk factors for PAD who were also experiencing pain while walking had even heard of PAD. Of that 25 percent, only 14 percent knew it was the leading cause of leg amputations.
“Studies have also shown that even with a diagnosis of PAD, medical treatment is less likely to be maximized compared to patients with other forms of atherosclerotic disease such as coronary artery disease and stroke,” Dr. Mullins adds.
Awareness is also the leading factor of chronic venous diseases going untreated. Although many are aware of varicose veins, they do not realize venous disease can cause swelling, skin changes, and ulcerations. Dr. Mullins continues: “Many physicians are also not aware of the manifestations of venous disease and often misdiagnose the inflammatory skin changes as cellulitis.”
For PAD, a simple screening called an ankle-brachial index compares the blood pressure in the arm to the blood pressure in the legs and toes. Once it has been diagnosed, it can be treated. Statin therapy, the use of drugs commonly used to reduce cholesterol, is the first recommendation, with antiplatelet therapy following.
Modifiable risk factors, such as a cessation of smoking, losing weight, and walking at least 30 minutes per day can play important roles in the treatment for both arterial and venous disease. “Regular exercise is extremely important,” states Dr. Mullins. “Walking increases collateral blood vessels in the legs, which help get more oxygenated blood past areas of narrowing. In chronic venous disease, the compression of the veins by the muscles during walking helps propel the blood towards the heart, which decreases the pressure within the veins below the knees and reduces symptoms.”
Chronic venous disease can also be treated conservatively with compression garments. “Knee-high or thigh-high compression stockings of at least 20-30 mmHg of compression should be worn daily while awake,” the doctor recommends. “Patients are also advised to elevate their legs multiple times throughout the day and at night. Proper leg elevation requires the feet being above the level of the heart.”
Walking the Path
Knowing his path early on meant Dr. Mullins could walk the path that much longer. Since deciding on interventional radiology, he says, “I am always on the lookout for new and innovative ways to help my patients.”
Of those new ways, is the out-patient, non-surgical, non-invasive approach to treating pain related to a variety of ailments. At CTET, embolic therapies can be employed for knee pain associated with osteoarthritis or hemorrhoids, or for women with uterine fibroids. Women have experienced successful outcomes with a non-invasive treatment called UFE, potentially limiting their need for hysterectomy.
The doctor and his colleagues at CTET and Heartland Vascular Care are passionate about exploring and implementing any of these innovative methods to treat the aggressive host of diseases that can so negatively affect their patients’ lives.
Heartland Vascular Care’s passion extends to educating not only their patients but also other physicians about the potential dangers of these vascular conditions.
When it comes to your health, knowing something is wrong is the first step toward correcting that problem. Knowledge, after all, is power. And it could very well be the power to save limb and life.
Cardiac Thoracic Endovascular Therapies, Heartland Vascular Center, is located
at 2420 West Nebraska Avenue in Peoria, Illinois. If you have questions about your
health or the health of a loved one, please give us a call at (309) 680-5000 or visit
us on the web at www.hlvcare.com.