Massage & Bodywork

September/October 2010

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pathology perspectives BY RUTH WERNER ATHEROSCLEROSIS IN THE LEGS Peripheral Artery Disease Picture this: your client is a 76-year-old man who is moderately overweight. Since his mild heart attack three years ago, he is fairly active and careful about his diet. He does his best to manage his diabetes, but he has been unsuccessful in his attempts to quit smoking. He likes to try to walk a mile every day, but he recently began experiencing some pain in his left calf after about half that distance. He describes the pain as sharp and knife-like, and it is only relieved when he stops walking. He tried a stationary bicycle, and the same thing happened. He is hoping he just pulled a muscle in his leg, and he wants your help so he can start exercising again. Sounds pretty straightforward, right? Wrong. My advice: proceed with caution. WHAT IS PERIPHERAL ARTERY DISEASE? Most readers are probably familiar with the term coronary artery disease (CAD). This describes the condition of having fatty plaques in the arteries that supply the heart. The same process commonly occurs in the carotid arteries leading up to the brain, which of course raises the risk for cerebrovascular accident (CVA), otherwise known as stroke. But the coronary and carotid arteries are not the only structures vulnerable to plaque development. This process can also occur at the renal arteries and in the legs. When it occurs away from the heart and brain, this condition is called peripheral artery disease (PAD); when it is specifically in the legs, specialists call it lower extremity atherosclerotic disease. PATHOPHYSIOLOGY The pathophysiology of PAD is similar to that of coronary artery disease. Because heart attack and stroke are the first and third leading causes of death in the United States, and because they are closely linked to the development of atherosclerosis, it is in every massage therapist's best interest to be familiar with the course of these conditions. The process of developing fatty plaques in the arteries is complex and probably has subtle differences in each individual, but in broad strokes the sequence has three main steps: fat is deposited in the tunica intima, plaques develop, and eventually they may complicate into more serious lesions. FATTY STREAKS These are lesions that indicate damage inside medium and large arteries. When the tunica intima is damaged, monocytes (small, mobile white blood cells) arrive to help clean up the debris. Then, they may move in and become permanently installed macrophages that specialize in connect with your colleagues on 97

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