View Full Version : Peripheral Arterial Disease (WARNING: Trigger)
If your health anxiety revolves around self-testing, I suggest you don't read this post.
Hello everyone
After my post on here last Friday saying how glad I was to have had my first CBT, I spiralled big time.
I had been suffering from (mild) erectile dysfunction for a while. GP wasn't worried due to my age, but ED can be a harbinger of CV problems in young men.
Long story, I spiralled and ended up reading about the diagnostics of Peripheral Artery Disease (which can cause ED). They use the Ankle-Brachial Index, which compares blood pressure at the arm and ankle, using a doppler.
Yes, you've guessed it. I measured my BP at ankles and arms, and got results ranging from 1.01 to 1.06 at rest. You simply divide the systolic at the ankle by the systolic at the arm. A normal result is 1.0 or above. However, when I came in from work and had been walking around, this reduced to 1.01 and even went as low as 0.91 (Results of 0.91-0.99 are borderline)
I'm worried I have PAD at 25. Yes I've been a heavy drinker and was a heavy smoker, but I didn't think I could get it at this age.
I'm seeing my GP next week regarding this. Surprisingly I'm not actually that anxious... I'm just thinking it makes sense with the whole erectile dysfunction thing.
Needed a rant as I'm certain from these scores I have some hardening of the arteries. And not a fantastic prognosis!
ABPI has to be done whilst your laying flat, how did you do that by yourself? I see you work in healthcare, did you borrow a doppler from work to do it at home?
I have Peripheral Arterial Disease. You don't. "Told Ya So Gang" on standby :winks:
Positive thoughts
I was obviously moving about during it (although I was flat). I didn't have the doppler lol.
What worried me is I can't find my dorsalis pedis pulse on either foot, however, the posterior pulse on the ankle is present on both sides. My grandmother also had this as a result of heavy heavy smoking. Worried about genetic aspects. Once she quit smoking, though, she never had any problems relating to her leg again. I should probably quit vaping.
Trying not to spiral over this
AMomentofClarity
05-12-18, 20:46
Just curious about the reason for the “trigger warning.”
I see no difference between this post and any of the others on here in which the op diagnoses themselves with a condition they don’t have.
I suppose just incase other readers who worry about CVD see how to measure it themselves and start a spiral
AMomentofClarity
05-12-18, 20:52
You also know too that by far and away the primary cause of ED in men under 40 is anxiety/depression......and you’re posting to an anxiety site...so...:whistles:
utrocket09
05-12-18, 21:27
I was obviously moving about during it (although I was flat). I didn't have the doppler lol.
What worried me is I can't find my dorsalis pedis pulse on either foot, however, the posterior pulse on the ankle is present on both sides. My grandmother also had this as a result of heavy heavy smoking. Worried about genetic aspects. Once she quit smoking, though, she never had any problems relating to her leg again. I should probably quit vaping.
Trying not to spiral over this
To test for PAD you usually have a full doppler scan done lying down. They also test you blood pressure in your arms and legs at the same time. Thats how I learned I have a vascular disease.
MyNameIsTerry
06-12-18, 02:35
You also know too that by far and away the primary cause of ED in men under 40 is anxiety/depression......and you’re posting to an anxiety site...so...:whistles:
Yep, that and the meds we are prescribed to treat them too. And I think we men tend to expect a steel girder occurs every time but forget the impact of stress (mental or physical) on the body doesn't always allow it.
I think the OP was just trying to be considerate with the trigger warning but as you said earlier, it's no different than many posts on this board.
I think the problem is I'm not on any meds that could cause ED. No antidepressants or anxiolytics.
I also took BP in left and right arm. Right arm was 7-10mmHg higher than left. Consistently. :( this is apparently another sign of PAD.
Definitely think my doctors appointment is warranted (for the first time ha)
EmmerLooeez
06-12-18, 12:51
Go to the doctor for reassurance for sure, but I don't think that you have PAD. PAD is one of my fears too! Honestly it sounds to me like your ED is caused by anxiety and your brain is looking for a physical reason rather having to face the anxiety and what may be underneath.
What symptoms are you having that might make you feel as though you have PAD, aside from ED?
From another healthcare professional with health anxiety. Xx
I don't really have any other symptoms. Sometimes my legs feel a bit tired after climbing stairs - but I remember having that since I was young. Like 14. So I doubt that's PAD related. Esp because my 'tests' put me at low normal.
I have read case reports online, but they all had claudication. Which I definitely don't.
Really what's making me think PAD is:
* absence of dorsalis pedis pulse (although this can be normal in 2-12% of the population)
* ED
* My blood pressure has been high normal for a while. Dr won't rx antihypertensives. If I was in the States, I'd be on BP meds
× intra arm difference on BP
* family history grandmother
× former heavy smoker /very heavy drinker
Surprisingly I'm not sick anxious with this. More so want to get to the bottom of it.
To test for PAD you usually have a full doppler scan done lying down. They also test you blood pressure in your arms and legs at the same time. Thats how I learned I have a vascular disease.
Agree.
I had one last year, they use the doppler to find your pulse in the feet and arns, tighten the blood pressure cuff until the pulse is no longer there, release the cuff when the pulse comes back and take your pressures at that point, so you can't do it yourself as you need a doppler and to be laying flat.
Even if you look at the results you got RadioGaGa they are within normal limits, but they wont be correct anyway.
FYI i'm 45, smoked for nearly 30 years and my results were 1.0, so not ideal but ok.
---------- Post added at 13:54 ---------- Previous post was at 13:49 ----------
I don't really have any other symptoms. Sometimes my legs feel a bit tired after climbing stairs - but I remember having that since I was young. Like 14. So I doubt that's PAD related. Esp because my 'tests' put me at low normal.
I have read case reports online, but they all had claudication. Which I definitely don't.
Really what's making me think PAD is:
* absence of dorsalis pedis pulse (although this can be normal in 2-12% of the population)
* ED
* My blood pressure has been high normal for a while. Dr won't rx antihypertensives. If I was in the States, I'd be on BP meds
× intra arm difference on BP
* family history grandmother
× former heavy smoker /very heavy drinker
Surprisingly I'm not sick anxious with this. More so want to get to the bottom of it.
Is the dorsalis the one on the top of your foot, between your big toe and 1st toe? A GP had terrible trouble finding mine with his fingers and said it was very weak. When i had my ABPI done they found it easy with the doppler and it was strong.
Yeah it's the pulse on the top of the foot. It's definitely not palpable on either side. But the posterior pulse on the ankle is strong which I take as a good sign.
Im not sure how I'm going to explain to my GP that I've spiralled so much as to self diagnose PAD. I'm also not entirely sure every GP surgery can even test for this - I think sometimes it's a referal?
Yeah it's the pulse on the top of the foot. It's definitely not palpable on either side. But the posterior pulse on the ankle is strong which I take as a good sign.
Im not sure how I'm going to explain to my GP that I've spiralled so much as to self diagnose PAD. I'm also not entirely sure every GP surgery can even test for this - I think sometimes it's a referal?
My GP surgery did one a week after i was taken to A&E and was waiting to see a vascular consultant. I waited 10 weeks to see the consultant ( had to push even though it was an urgent referral and going to be 4 months) and had another ABPI 5 mins before seeing the consultant.
AMomentofClarity
06-12-18, 16:13
Im not sure how I'm going to explain to my GP that I've spiralled so much as to self diagnose PAD.
So you recognize the irrationality then???
ED is not a diagnostic tool. It’s a condition that CAN be associated with physical health problems, especially in men over 40. In younger men it is usually caused by anxiety/depression.
As far as the condition itself, I know nothing about it. But in reading others’ posts it sounds like your self test/self diagnosis are complete garbage if I can be blunt.
MyNameIsTerry
06-12-18, 17:05
Im not sure how I'm going to explain to my GP that I've spiralled so much as to self diagnose PAD.
I think telling your GP the tests you have done will be a red flag for anxiety. :winks:
You said you weren't on antidepressants. I only mentioned that as one known culprit as I wasn't sure if you took anything and given your field of expertise you will know a lot more about that than I would. But just anxiety alone can easily cause erectile issues so I think you have to be wary of joining up dots that aren't there. It could be distinct from other symptoms you are talking about here and combining them could lead you to the wrong conclusions.
The self testing does look quite detailed but perhaps it's worth remembering you are in the medical sector and it may appear less so to you. I'm sure you would agree seeing this on a thread with another member's name at the top would raise your eyebrows about how the testing maybe be flawed (bias, lack of knowledge to compensate for manual errors, etc).
MyNameIsTerry
I do agree with you on that one haha regarding telling this to my GP. Last time I saw her was regarding the infamous "changed mole" and, let's just say she was rather short and told me to stick to drugs whilst she stuck to diagnostics :blush:
But, on a more serious note, I had obviously started out by looking at what medication I'm on: Flutiform (Asthma) Salbutamol (Asthma) and Lansoprazole (GORD). Interestingly, impotence is rare (e.g. ~1 in 10,000) side effect of lansoprazole. I've also started myself on Aspirin!!!
Another interesting thing I've read online is that asthma is associated with both atherosclerosis (e.g. the cause of PAD) and also erectile dysfunction. I've been an asthmatic since birth. I wouldn't let this freak anyone with asthma out - if the link was that strong, we'd be told about it and monitored for it!!!
As well, subclinical atherosclerosis is present from the teenage/early 20s years. This is essentially normal and nothing to be worried about over time, unless you're doing the things they tell you not to i.e. smoking/drinking/excercise/diet etc etc. It's just most people don't get symptoms of it e.g. PAD, Coronary artery disease etc until >50
I am sort of prepared for a bit of bad news... Reading a couple of case studies online, it appears automatic blood pressure machines can give a very good idea of the patients ABI :-(
I finally bothered to book myself in for the HbA1c (for diabetes) & cholesterol test on Monday, which my GP had wanted me to do back in September (bad patient, I know). She's then phoning me sometime before 12:30 to discuss my most recent issue (I just told the nosey receptionist it was relating to my impotence!! She didn't inquire any further once I said that :D )
I suppose another reason I'm not entirely freaking out is because my uncle had a triple by pass 30 years ago. He's currently 76 and doing *extremely* well. So, even when CVD is diagnosed in a patient, when they seriously improve their lifestyle, as he did, it just goes to show how well they can do.
Sorry I'm ranting so much!
EmmerLooeez
06-12-18, 21:51
Gaga!! :d I've just had the diabetes and cholesterol test done today lol! My GP ordered it months and months ago and I finally got around to it. I'm sure both of us are fine!
Emmer
Hahaha, my GP and I have a good rapport, but I can almost hear her asking "have you done the tests yet?" when she calls on Monday. I'll just have to apologise and say I've been too busy so I did them that morning :D
Now, as for how she'll react when I request an examination of my legs and arms :roflmao:
EmmerLooeez
06-12-18, 22:59
I'm quite open with my doctor about what I think is wrong with me lol. He diagnosed me with carpal tunnel on Monday and I went in there to tell him I either had MS, PAD or heart failure. FFS :d
The amount of research and self testing is in and of itself not normal to say the least. I stand by my post that this is not PAD. It's just not physically feasible at your age. You would be in the medical journals if it was!
I agree with some of the other posters that anxiety, depression, meds etc. are the main cause. When you see your doctor, I advise you to discuss your mental health and seek help. To continue to pursue this type of behavior will only prove to exasperate your symptoms and carry over to other physical symptoms. Also look into the many resources here (https://www.nomorepanic.co.uk/articles) for self help and explanations of your symptoms.
Positive thoughts
Thanks Fishmanpa _ I really am aware what I've done isn't normal. It's refreshing in a strange way for my HA to resolve around something other than glioblastoma. Although it would be even better to not have it all.
My GP just phoned and was very nice about it all. She did say it's practically impossible for me to have PAD at my age, but because since this post started, I was able to find a weak dorsalis pulse on the right foot, the left being absent, she said to come in and she'll examine the pulses etc.
She phoned her receptionist and told them it was a routine appointment, therefore I'd not get in until January.
So I'm just going to have to put this to the back of my mind until then.
My uncle has had CAD and PAD for a very long time now, having had a triple bypass nearly 30 years ago and he's doing very well. So there are definitely much worse things than this!
Shadowhawk
10-12-18, 14:20
Thanks Fishmanpa _ I really am aware what I've done isn't normal. It's refreshing in a strange way for my HA to resolve around something other than glioblastoma. Although it would be even better to not have it all.
My GP just phoned and was very nice about it all. She did say it's practically impossible for me to have PAD at my age, but because since this post started, I was able to find a weak dorsalis pulse on the right foot, the left being absent, she said to come in and she'll examine the pulses etc.
She phoned her receptionist and told them it was a routine appointment, therefore I'd not get in until January.
So I'm just going to have to put this to the back of my mind until then.
My uncle has had CAD and PAD for a very long time now, having had a triple bypass nearly 30 years ago and he's doing very well. So there are definitely much worse things than this!
BTW, i will say one thing - the dorsalis pulse is one of the hardest pulses to find, and if you search (but don't, since i have already done it for you.. :P), you will see nurse/doctor learning forums filled with people getting tips on how to actually find it. So, if the trained professionals find it difficult, just think about how novices like us bumble around... :whistles:
Haha i need to keep reminding myself to stick to pharmacy. I had read that it was difficult to find too. But my posterior pulse was very easy to find I thought.
Just wish I could enjoy my life and stop worrying about what may happen
Well everyone my Hba1c came back as normal (didn't ask for number)
My total cholesterol is 2.6mmol.
Will keep everyone updated
Hello everyone - thought I'd post an update
Saw my GP this afternoon regarding the dorsalis pedis pulse being absent. GP felt my foot for quite some time and confirmed the pulse was indeed absent.
It was faintly present on the right foot, but totally absent on the left.
Thinking she'd take it a bit more seriously, she said it would only concern her if I was a smoker and had diabetes.
We then measured my blood pressure, which was 149/89. We waited a few minutes, took it again, and it went down to 148/89 (!). She said this was "fine" and we didn't need to treat it!!!
Wasn't really what I was hoping for... Especially with the blood pressure readings consistently being high, even at home on ambulatory monitoring. But, I'll see how things go
Anyway, just thought I'd update you all.
Wasn't really what I was hoping for...
What were you hoping for? :huh: As I said, based on your age and physical health confirmed by tests and exams, you're fine. A little white coat syndrome is all that's going on with your BP. I know you feel fobbed off but there's no reason to pursue anything.
Positive thoughts
Thanks for the reply Fishmanpa
I really had wanted to look at starting meds for the blood pressure, especially because I'm consistently running high at home. I'm honestly not *scared* of having hypertension, more so I'd prefer to have it under control sooner rather than later. The American College of Cardiology have recently said anything over 120/80 is now pre-hypertensive, with stage 1 being >130/80. (*Considers moving to America :D*)
And then obviously I was surprised by the "yes, your pulse is very weak on one side and completely absent on the other, but this is fine". I definitely felt fobbed off there because she admitted she'd found something that isn't exactly normal, but because I don't have diabetes it's nothing to worry about?
Meh, I wish she'd at least offered ambulatory blood pressure monitoring at the least. But, its NYE so I'm going to try and forget about this and hopefully one day I'll get those blood pressure meds! :roflmao:
Happy New Year Fishmanpa and to anyone else reading this post
MyNameIsTerry
31-12-18, 18:42
So you had the 24 hour BP test? Did they see constant high readings?
As for differing standards, I'm sure you know that more than most on here. Just because it's the US doesn't always mean we will follow as we don't in mental health where the US seem to want to diagnose normal emotions as a disorder (in some cases). And it's whether a small decrease in a threshold has much value. They may be leading the way too in fairness.
Ah, the joys of BP meds. Months of intense itching, switching, more itching, now antihistamines are my go to pill whilst my skin tries to recover which is taking months. My mum had that messing around for years until they got it right. In hindsight, I'd rather not have the added faffing whilst my docs just write a new script and don't have to put up with the messing about.
So, if you really don't need them then it saves you some potential unpleasantness in my book :winks:
Sorry I should've been clearer - when I said its higher on ambulatory, I meant when I'd monitored it myself.
With regards the US standards, certainly all the evidence points that the lower the better. Although 120/80 is great, if you can get it lower than that, even better. So this is one area where I am completely behind the guidelines issued in the US. Patient UK Professional Reference (Article: Hypertension) mentions these guidelines and recommends UK doctors take them into account when treating htn
Amazing to think that not THAT long ago, they considered your blood pressure should be 100 + your age!
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