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Walking with the unknown

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Rita Smith, 59, of Mason Neck, Va., is once again able to enjoy one of her favorite activities -- walking her dogs -- now that she's been treated for peripheral arterial disease. (Courtesy of Rita Smith)

Rita Smith is a fitness fanatic and step aerobics is her passion, so when the familiar motions in class left her with an unfamiliar pain, Smith knew something was terribly wrong.

“As soon as I stepped up onto the step with my right foot, I was in so much pain,” Smith, 59, said, “but as soon as I stopped, the pain went away.”

Smith, of Mason Neck, Va., tried to go on with her daily life, going for mile-long walks each morning, but the pain caught up with her. After one particularly excruciating walk, she removed her right shoe and took a closer look.

“My foot was completely white,” Smith recalled. “No blood was circulating to my foot in my shoe.”

It took six months and several tests to discover what was really going on in Smith’s right foot. Peripheral arterial disease, also known as PAD, was the culprit.

“I had never heard of this disease before,” Smith said

Like many Americans, Smith ignored the situation because she simply thought having trouble walking was part of getting old. And, like many Americans with PAD, Smith was putting herself in danger of something even greater: the heart attacks and strokes that doctors in recent years have found often follow this symptom traditionally seen as a mild inconvenience.

“There are a lot of things that can cause pain when you walk once you’re older, like arthritis and back problems,” said Dr. Diane Treat-Jacobson, assistant professor in the school of nursing at the University of Minnesota and author of a recent PAD awareness study published by the American Heart Association. “Many older people think it’s just another part of aging, so they don’t bother to talk to their doctors about it.”

Only 25 percent of Americans are aware of PAD, even though it is both common and dangerous. Roughly nine million American men and women are affected with the condition, which is associated with a high risk of heart attack and stroke.

Although this disease affects one in 20 Americans over the age of 50, people were more likely to be aware of other diseases that affect fewer Americans: According to the study. 36 percent knew about Lou Gehrig’s disease (which affects 30,000 Americans); 42 percent knew about multiple sclerosis (which affects 400,000 Americans); and 31 percent knew about cystic fibrosis (which affects 30,000 Americans).

Part of the reason Americans are unaware of PAD, which occurs when arteries in the legs become clogged with fatty deposits and reduce blood flow there, is that only in the past 20 years has it found to be a major red flag for heart disease and stroke, said Treat-Jacobson.

It turned out that the blood flowing through Smith’s body was coming to a full stop in her right leg because of a large blockage in her knee, and she was just as likely a candidate for PAD as any man.

“We tend to think of coronary disease as one primarily of men, but PAD is definitely an equal opportunity disease,” Treat-Jacobson said. “It’s often thought that more men have this type of disease and women might think, ‘Oh, I don’t need to worry about that.’”

The risk of PAD for both men and women increases after the age of 50 and for people who have diabetes, high blood pressure or high cholesterol.

Also at risk are smokers and former smokers, like Smith: Though she quit 20 years ago, she used to smoke heavily, going through 40 cigarettes per day.

Together with his own history of smoking, Daniel Sullivan, 68, who has high blood pressure and high cholesterol, was at high risk for heart attack and stroke when he felt a similar pain in his left leg four years ago.

Once a runner on his high school and college track teams, Sullivan, of New York, found it “kind of ironic” that someone who spent eight years running as much as he did would have leg problems today.

His golf hobby was the first to go when Sullivan could no longer bear the pain he felt in his legs when walking.

He continued to ignore it until he went out for dinner with friends one night and had to walk several city blocks to reach the restaurant.

“I could walk about three blocks and after that the pain would become more severe,” Sullivan, also a former smoker, said, “at which point I would either have to wait at the corner or start limping.”

Sullivan’s friends noticed he was lagging behind, and encouraged him to see a specialist.

It turned out that PAD, a disease he too had never heard of, was responsible for his pain, and his doctor inserted a stent in an artery in his left leg.

Often, people don’t even have symptoms or the symptoms are hard to describe to doctors, Gwen Twillman, executive director of the PAD Coalition, based in Washington, D.C., said, and might only manifest when the case becomes advanced--a blister or a sore on the foot that does not heal in four to six weeks.

“This is a sign that the blood isn’t getting to your foot to heal that wound,” Twillman said.

Some therapies that people with PAD can try to control the disease and lower their risk of heart attack or stroke include stopping smoking, taking aspirin, lowering cholesterol and taking anti-platelet medications.

In addition to the risk to heart health, simply putting a stop to the pain was what motivated Smith to consult with her doctor.

“I used to walk a mile a day,” she said, “and then I couldn’t even walk to my mailbox without having to stop. It was like a clamp on my leg. It felt like a shin splint in addition to a pulled muscle.”

E-mail: jmf2151@columbia.edu