July 25, 2007

When Pete Thompson* complained of leg pain when walking for five minutes and numbness in his toes, his care team at Sauk Prairie Memorial Hospital & Clinics was quick to diagnose the cause and provide treatment.

"I could walk, but not very far. And when I did, I would get pain," describes Thompson, age 73. "I just kept going - kept pushing myself."

"Pete was showing classic signs of peripheral vascular disease," says Julie Esser, SPMHC's cardiac rehab specialist who had been providing cardiac rehabilitation services to Thompson since he had undergone cardiovascular surgery in the fall of 2006. The fact that his leg pain was very predictable - always after five minutes of walking - was a strong indicator that its cause was vascular in nature.

"Julie was the one who said I should talk to someone about my legs. That's what kind of pushed me to talk to Dr. Ensminger about it," says Thompson, who had been a smoker his entire adult life until he quit for good prior to a triple bypass surgery in 2000.

"It's so important for patients to tell their doctor when they're having pain or experiencing anything out of the ordinary," explains Dr. Scott Ensminger of Sauk Prairie Internal Medicine, Thompson's primary care physician. "The earlier we can pinpoint the problem, the sooner we can treat it - and hopefully that results in less invasive treatment and quicker recovery time.

"Ensminger ordered a series of painless, noninvasive tests at SPMHC for Thompson, including a pulse volume recording (PVR) and an ankle brachial index (ABI), which confirmed what his care team had feared - atherosclerotic disease or a narrowing of the blood vessels from plaque build up which reduces blood flow to the legs. If left untreated, Thompson would begin to experience pain with walking sooner and would likely develop non-healing ulcers on his feet which could ultimately result in limb loss.

For surgical treatment, Thompson chose general and vascular surgeon Dr. Derek B. Johnson of Surgical Associates in Prairie du Sac. Johnson, who completed his residency at Berkshire Medical Center in Pittsfield, Mass. where he received the Award for Excellence in Vascular Surgery, ordered another noninvasive test for Thompson - magnetic resonance angiography (MRA). An MRA checks the arteries and determines the exact location and size of the plaque build up.

"Dr. Johnson and Dr. Ensminger are both great guys," Thompson acknowledged. "They're not afraid to take the time to sit down and talk to you. I like that."

With the results of the MRA in hand, Johnson diagnosed Thompson with iliac artery disease in both legs. The treatment, which began with his left leg in March followed by his right leg in May, required a stent in his iliac artery and a bypass of his femoral artery.

For the stent, the less invasive of the two procedures, a balloon is placed in the iliac artery to widen the blocked area before placing a stent, or cylindrical wire mesh tube, which expands, keeping the artery open.

"Unfortunately, Pete could not have a stent in his femoral artery because of the length of the occlusion, which is why we had to do a bypass," explains Johnson. "Essentially we just circumvented the narrowed area by plugging into the blood vessel above and below the lesion, allowing blood to bypass that lesion thereby improving blood flow down to the lower part of his leg."

After a five-day hospital stay, it was time for Thompson to finish his recovery at home. "I was so impressed, I didn't want to go home!" he declares. "The nurses and aides, the housekeepers - they were simply great! I've been to other hospitals that are supposed to be great hospitals, and I've never had the treatment that I get in Sauk!"

Fortunately for Thompson, his good friend, LuAnn Hohneke, helped care for him when he returned home and still continues to look after him. "She knows what I can eat. When I order something I shouldn't, she'll say, 'You can't have that Pops!'" Thompson laughs. "What do you do with friends like that?"

Johnson says that, like Thompson, most people feel immediate relief. "Before the surgery, he said his toes were very brittle and always cold. Now they're warmer and he can move them freely," explains Johnson. "In his case, he had two surgeries on each leg and, with his age, he's going to need some recovery time. Most people who have this type of surgery also experience some swelling in the lower extremities from increased blood flow."

Thompson's recovery includes regular exercise, which he gets at SPMHC's River Valley Medical Clinic in Spring Green. His membership there includes use of the clinic's exercise equipment. "I'm still a little bit sore, but nothing like I was," he says. "It's like anything else, if you want it to work, you've got to work it."

According to Johnson, reducing your risk factors - stopping smoking, controlling your cholesterol and blood pressure - along with early detection is the key. "If you catch it early, a lot of times you can do an endovascular procedure - such as ballooning and stenting through a very small incision - which is going to be less difficult on the patient. The longer you wait, the more extensive the disease, the harder it is to fix," he says.

"It's also important for people to realize that we can do these surgeries in Sauk Prairie," says Johnson, who has been treating surgical patients at SPMHC for more than a year. "We have everything we need here to do what we need to do."

*Name changed to ensure patient confidentiality .

Scott A. Ensminger, D.O.
Internal Medicine
Sauk Prairie Internal Medicine

Iliac artery blocked with plaque which reduces blood flow to the legs

Stent placed in iliac artery, restoring blood flow to the legs

Blocked femoral artery

Are You At Risk?

Risk factors for vascular disease include:

• 55 years or older
• smoker
• high cholesterol
• high blood pressure
• family history of vascular disease
• diabetes
• other signs of hardening of the arteries in the past (stenting, heart attacks, etc.)

If you have risk factors for vascular disease, talk to your primary care doctor about getting tested. Vascular testing is noninvasive and nearly 100 percent accurate. To schedule an appointment with Dr. Ensminger, call 608-643-2471. For more information about peripheral arterial disease, visit Surgical Associates' website at www.saukprairiesurgeons.com.