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Your Leg Pain Questions Answered with Dr. Joshua Dearing

September 9, 2019


Hi. Good afternoon. I’m Dr. Joshua Dearing and I want to welcome
you to our first lunch and learn Ask the Doctor series. I am a vascular surgeon and I will be speaking
to you today about the different causes of leg pain and how we evaluate them and how
we treat them. As this is a Facebook Live event, I welcome
you to ask any questions along the way as they pop up. I’ll do my best to try to answer them or we’ll
save them at the end to answer them all together. So a little bit about myself. I grew up in North Carolina. I went to college at Duke University and then
I did med school at UNC Chapel Hill. I did my general surgery residency up in New
York City and then I came back to D.C. for my vascular surgery training. And then, I liked it so much in the area,
I decided to stay and I’ve been working here ever since. So I really enjoy the area and I really enjoy
the people here and so, it brings me a lot of pleasure to be able to help everyone around
here. So some of the main causes of leg pain can
be broken into one of two things. That’s either problems on the arterial side,
which the arteries are the parts of the body that bring blood from the heart all the way
to everything that’s far away from the heart, all the way to your fingertips to your toes. And you can have pain for different reasons
in the arteries, which we’ll talk about in a minute. What brings blood back from all of those parts
of your body back to your heart are your veins. So they do a little bit different functions
and as a result, they can give you different causes for pain. Now, one of the more common causes of leg
pain that people may experience is that they have issues with their veins. Now, our veins are supposed to make sure that
the blood only goes back to our heart, but sometimes, those veins don’t work properly. And the reason that happens is it’s usually
genetic. It’s not anything that you do, it’s not anything
that happened, but sometimes your veins just don’t work as well as they used to. And so, what we have to do is try to figure
out whether your veins are working properly or not and one of the main ways that we do
that is just with a painless ultrasound. We take a look at the veins in your legs,
see if they’re working the way they’re supposed to, and can decide if you need something to
help you along with that. Now, people who have leg pain from veins unfortunately
can have a lot of different symptoms. Sometimes, it’s a little tough to pin down
exactly why you would have leg pain from your veins. So most people complain of heaviness in their
calves or their thighs. It’s usually worse after you’ve been working
for several hours or have been on your feet for several hours. Some people will notice swelling. Like, they’ll notice swelling in their ankles
at the end of the day and then when they wake up in the morning, they’ll notice that their
legs are back to normal. Or you may have visible veins. You may have spider veins or larger veins
or even sometimes those bulging varicosities, the varicose veins, which can indicate that
you’re having kind of venous problem. So what we do is if you feel like that’s the
source, we have you come in. We do that ultrasound. We take a look at you and we can see if there’s
anything that we can do to help you with that. Vein problems are not life-threatening or
limb-threatening. The main issue with vein problems is, of course,
just discomfort. And the main treatment is just wearing compression
stockings, which doesn’t sound amazing, but they do help people feel better and they can–
they’re actually pretty simple to use. If you have bigger vein problems or have something
that we can address, sometimes we can do injections or do small procedures to either get rid of
those veins that are not working or do things to improve your symptoms, and these are all
very minor surgeries or procedures, some of which we do in the office. Now, Deborah [ph?] from Waldorf posted a question
and she said that she gets a lot of nighttime Charley horses. Is this a symptom of something that’s more
serious and how can I avoid them? So again, sometimes people do have cramping
in their legs at night from vein problems. Again, it’s very tough to tell without getting
the whole story. Sometimes, people get Charley horses in their
legs just from not having enough potassium or magnesium. Usually, it’s not a sign of anything really
terrible. It’s just one of those little things that
you can fix with either a vitamin or with getting a vein workup and seeing if there’s
anything that we need to address on that standpoint. So– in terms of other issues that can happen
with your legs, if they’re not caused by spider veins or varicose veins or swelling like that,
you can have problems with your arteries. Now having arterial problems is a little bit
of a bigger deal because arterial problems are actually an issue with blood getting to
the tissues, the muscles, the skin in your legs, your feet, and your toes. And so, we want to make sure that if you have
that problem, we do things to avoid and improve that. So people get problems with their arteries
because they get plaque build-up in those arteries, and it’s the same thing that happens
in people’s hearts that cause them to get a heart attack, but instead of the plaque
building up in their heart, it builds up in arteries of their legs. Now, people get plaque build-up for a couple
of different reasons. A lot of it genetic. Some people just unfortunately build up more
plaque than others. But there are some causes of plaque build-up
that can be modified or can be treated. So some of those causes, the number one, the
biggest one, is smoking. So if you’re a smoker, this is going to accelerate
the building up of plaque in arteries that go to your legs, to your heart, and even to
your brain. If you have high blood pressure, it damages
and irritates the arteries and as a result, you can have more problems with plaque build-up. If you have diabetes, unfortunately, diabetes
leads to an acceleration in the build-up of this plaque. And finally, which makes the most sense, if
you have high cholesterol. Now, most people with high cholesterol at
this point, again, it’s genetic. You do have some high cholesterol from your
diet, but a lot of it is from just being lucky in that genetic lottery. Now, how do we fix that? You know, a lot of people ask me is there
a medication that I can take for having this plaque build-up in your arteries? Now, everyone has some plaque, but the question
is do you have too much? The main thing to do is to kind of modify
those risk factors that we mentioned. So if you smoke, you should try to cut back
and quit smoking. If you have high blood pressure, control your
blood pressure. You have high cholesterol, we have medications
for that. If you have diabetes, obviously, you understand
that’s a very difficult problem and you do your best to control it and the best that
you can do can help with this. In terms of other medications, aspirin is
a very great medication. If anyone identifies any kind of plaque in
your heart or your legs or anywhere else, you should probably be taking a baby aspirin
every day, if you’re not allergic to it, and this is something you should talk about with
your primary care doctor or you can talk with any of your other doctors. In addition, the two other things that can
help with the plaque build-up in your arteries involve exercising and eating right. Now, neither of those sounds fun, but they
are very helpful at decreasing the plaque build-up and in some cases, can actually reverse
some of the blood flow issues that you have. So Rachel from Clinton posed another question
that I’m going to address. She says that she’s 28 and has diabetes. She doesn’t have any leg pain at this point,
but she knows she’s at an increased risk of having vascular problems or leg problems. She wants to know what she can do to lower
those as she goes forward. So again, the big things are— for diabetes,
it’s maintaining a good A1C. All of you out there that have diabetes or
know someone with diabetes, you know that the A1C is a magic number. So if you can keep that number as low as possible,
you prevent diabetes from damaging any of the parts of your body, including arteries
in your legs. And then, of course, the other thing you can
do is just the simple act of walking three times a week for about 30 minutes. You don’t have to jog. You don’t have to run. Just walking at least three times a week for
about 30 minutes can actually help the blood flow in your legs. It helps remove a little bit of that plaque
and it also helps your body grow new blood vessels around the problem. And in addition, like I said, you can manage
all those other issues, your cholesterol, your blood pressure, and smoking, which I
know is very difficult to fix. Now, people who have arterial problems, they
usually have a more distinct set of symptoms. So with veins, it’s a little complicated because
sometimes you can just have heaviness or cramping or, as Deborah said, you can have Charley
horses at night. If you have arterial problems, or real circulation
problems, the main thing you’re going to notice is that when you’re walking a far distance
or if you’re more strenuous walking, like walking uphill or upstairs, you’re going to
notice calf pain. Your calves are going to hurt like you just
ran a marathon and you’re going to stop after a period of time. That pain’s going to go away. You’re going to start walking and then it’s
going to come back. That is the most tell-tale sign of having
some kind of arterial leg pain issue, and it affects a lot of people. Most of the time, it is not life-threatening
or limb-threatening. It’s something that we can address simply
and get you feeling better with either exercise, medication, or sometimes small procedures. Now, when you have worse circulation problems
than that, sometimes you can develop pain in your feet or your leg all the time. Sometimes, that’s only better when you kind
of let your foot or leg drape in a dependent position, or down, so that gravity can help
the blood flow. And then, of course, the most serious sign
of having blood flow issues would be if you had any kind of wounds on your feet that did
not heal. And again, if you’re a diabetic, you’ve understood. People have talked to you about this. But for everyone else, you may end up getting
a wound that would not get better over the course of a week or so and that may be because
of poor blood flow. Now, Erin [ph?] posed a question and wanted
to know are regular leg cramps when laying down a sign of having any issues? Again, it kind of depends on their frequency
and when and some of the other things that we would see on an exam. It could be from, again, an arterial problem
or a vein problem. It would be something that we’d have to check
out in the office and figure out what the best test for you would be. But usually, if you’re able to walk without
pain, that’s a pretty good sign. Laura also posed a question, at what point
would you recommend getting a small procedure done for this? I think that comes down to a discussion that
we would have in the office. It depends on how much this leg pain bothers
you. I have patients who come in and they tell
me they only get leg pain when they walk two miles. And in that regard, they’re probably okay. But I also have patients who can’t make it
from the car to the door of my office building without having problems, and now, those people
probably need a little more than an exercise regimen and aspirin. So– again, it kind of depends on does it
prevent you from doing your job? Does it prevent you from playing with your
kids or with your grand kids? Those kinds of things, if you’re not able
to live your best life because of this leg pain, then I think it’s time for us to talk
about doing something a little more invasive than just trying aspiring and an exercise
program. We have another question. Megan [ph?] from Brandywine wants to know–
she says that she’s pregnant with her first child and that leg pain and cramping is fairly
common. What symptoms should make her more concerned? Pregnancy is a big– is a factor that can
worsen any kind of vein problem. So a lot of women don’t notice that they have
real bad vein problems until after they’ve had their first or second kids. Mostly, it would be leg swelling and pain
that was constant. That would be a worrisome sign. If you get it periodically or if it’s things
that are worse when you’re on your feet, that’s kind of just normal vein issues with pregnancy. But typically, pain that you have that’s consistent,
pain that doesn’t really get better with anything, would be more worrisome. Erica [ph?] from– Erica wants to know is
there a way to tell whether the leg pain is from something cosmetic or something that’s
a bigger deal and who can help determine that? Sometimes, your primary care physician can
help, but usually, you need the input of a vascular surgeon, like myself, to determine
whether this is a cosmetic problem or something that has a more significant underlying cause. And again, the test that we would do would
be something like an ultrasound to take a look. I have a lot of questions now. Kate wants to know how quickly symptoms may
improve or be resolved after treatment for arterial disease. That depends. It kind of depends on how bad your blockages
are. If you have some mild blockages, taking an
aspirin and walking around, you may actually feel better in a couple of weeks. If you have fully blocked arteries, you may
need something like a stent or something to balloon open that blockage. Most people feel better almost immediately
after the procedure. In the next few days, when they’re able to
walk around, they feel a lot better. Some more questions. Debbie [ph?] wants to know that she’s– she
says that she’s having issues with cellulitis in her right leg and that she’s had normal
testing, but she can’t get rid of the cellulitis. She has diabetes, high cholesterol, high blood
pressure, and that sometimes she has numbness in her feet. Is it time to see a vascular doctor? It may be. It definitely sounds like you have a lot of
things going on and potentially, blood flow issues may be contributing to that. One of the other things that can contribute
to cellulitis and leg swelling is the final topic that I wanted to talk about today, which
is something called lymphedema. Now, it’s a lot more common than people talk
about. It’s not a– but it’s not life-threatening
so it doesn’t get a lot of attention. But a lot of people can have swelling in their
legs that extends past their ankles onto their feet, which can cause a lot of discomfort
or sometimes people can have cellulitis. There’s a lot of different treatments for
lymphedema. Lymphedema can come from cancer, can be genetic. It can happen from surgery. So if you’ve had a lot of surgeries in your
abdomen, in your belly, or if you’ve had your hip or knee surgery, sometimes you can develop
lymphedema. Now, the main treatment for lymphedema, or
these swollen legs, again, it’s compression stockings. But if you truly have lymphedema, we can get
you signed up for either a lymphedema pump or to present you to the lymphedema clinic,
both of which help people feel a lot better. It’s a little bit tough to diagnose and it’s
one of those things that if you feel like you have, you either want to make an appointment
with a vascular surgeon or have your primary care doctor refer you to a vascular surgeon. Belle asked how do you know if you have a
blood clot in your legs? That’s a very good question. It’s definitely something that you see in
the news and on ads because there are a lot of new medications for blood clots in the
legs. That would be, again, pretty consistent. Pain in the leg that did not get better. Usually, it comes about after things like
a long flight, like if you fly for over 8 hours, or if you spend over 8 to 10 hours
in the car. But again, sometimes people just have a little
bit of swelling and a little bit of pain and if it’s something you’re concerned about,
you would need to get an ultrasound to really take a look. And then, one of our final questions for right
now is Nick from Upper Marlboro, and he wants to know why are my legs numb if I stand for
a long period of time? That’s a good question, Nick. A large part of my job has to do with trying
to determine where are people’s leg pain coming from? Now, I talked a lot about the vascular reasons
of leg pain because that’s what I do each day. But sometimes, you can have leg pain from
other things, such as things like back issues or spine surgery or nerve injuries. If both of your legs are numb at standing
or it’s worse when things like walking up stairs, that may be more of a spinal cord
or back issue. And sometimes, one of the biggest things that
I do is I actually tell people that they don’t have a vascular problem for their leg pain,
that it’s actually just from their nerves or from their back, and then we get them set
up with the right person. So some of the patients that come through
my door, they don’t actually end up having a vascular problem, which is good, but sometimes
they just need to have that screened out so that they can present to the appropriate doctor. Now, in terms of trying to figure out whether
you have an arterial problem or not, the main thing that we do is we see you in the office
and we check to see how strong your pulses are. Some other tests that we can do involve checking
the blood pressure in your legs compared to your arms. So if it’s a lot lower in your legs, that
would let us know that you have some circulation problems. We can do some ultrasounds, which give us
an idea. And then, if we need to do something more
invasive or something that we’re– to get a better picture, we can do CAT scans or we
can do angiograms. And the angiograms are one of the mainstays
of both identifying and treating vascular disease, and that basically involves a small
in and out procedure that we do here at Southern Maryland Hospital. And what we do is we just put a small tube
inside the artery and we use contrast dye to look at the blood flow and it gives us
a real-time picture of how blood is flowing in your legs. Can let us know if you have a blockage or
if you have some tight spots that are– that’s hindering blood flow from getting all the
way to your toes and to your leg. And those are things that we can fix at the
same time. Sometimes, all it takes is a little ballooning. You balloon the blockage out of the way. Or sometimes, we put a stent, which is like
a small mesh metal tube that pushes the plaque against the wall; keeps your blood vessel
open and helps blood flow by. Again, these are small procedures. Chances are you know someone who’s actually
had one done because it’s not an uncommon problem. And so, if you come in to see us, that would
be the– some of the things that we would take a look at. Like I said, we would check the blood pressure
in your legs. We’d take a look at your legs. And sometimes, we’d order some other testing. And then, if you felt it was bothering you
enough and we felt that you had a big enough problem, we would schedule you for something
like an angiogram, which would let us look at that blood flow and potentially treat you. I know none of this is stuff that people–
people don’t like going to the doctor and people don’t like starting new medications,
but these are things that can adversely affect your life and it’s better to get it treated
sooner rather than later. So that’s most of the talking that I have
to do. I hope I was able to explain kind of the three
main issues with leg pain. Like I said, most of it comes from the veins,
which we can fix with relatively simple ways. Sometimes, you have problems with circulation,
with your arteries, or sometimes you have swelling from what’s called lymphedema, and
again, there are things that we can do for you. So if you are having leg pain or you’re suffering
from discomfort or swelling or you’re not able to do the activities that you used to,
speak with your primary care physician doctor or make an appointment with us. I see patients every Friday here at Southern
Maryland Hospital. We still have plenty of room for new patients. You’re able to call my office to make an appointment. I’ll list it here and hopefully, they’ll also
be able to put it out there so you guys can find it. But the number for my office is 301-877-7353,
and that’s 301-877-7353. And we’re more than happy to see you for any
of these issues, or even just to tell you, you know what, you don’t have a vascular problem,
but here are some other doctors you may need to see. You may need to see an orthopedic surgeon. You may need to see a back surgeon. And more than happy to help you get on the
track to feeling better and getting back to being as mobile and as active as you want
to be. So if there’s any other questions, we’d love
to answer them, but I think that ends my lecture part.

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