Newspapers / Winston-Salem Chronicle (Winston-Salem, N.C.) / Jan. 6, 2000, edition 1 / Page 23
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For 25 Years, The Choice for African American News and Information January 6, 2000 C3 Issues concerning the well-being of the African American community ^ercise may help leg arteries for some IREYFUSS lOCIATED PRESS SHINGTON - For some Ts, pain can lead to gain - en, paradoxically, to less ny people with intermittent ation, a form of arterial dis- aracterized by leg pains and iss triggered by walking, can e their ability to walk pain- they take part in a walking |n, experts say. The catch is program makes them walk |iey hurt. at I tell my patients is to bur or five times a week to :t of pain - and a little far- jjut stop before it gets excru- said Dr. David L. Daw- in Air Force lieutenant who is an associate profes- surgery at the Uniformed s University of the Health :s in Bethesda, Md. :rmittent claudication is than simply a debilitating on, however. Clogs in the :ries are considered warning hat the patient may have ry artery disease as well, n said. Up to 40 percent of s with intermittent claudica- re dead within five years, from heart attacks and he said. srmittent claudication s more common as people 'Id. And most patients with ittent claudication don’t eatment, believing the pain akness to be just signs of Dawson said. ctors tend to pay little atten- 0 the claudication itself, g on the more severe prob- nderlying the leg pains, he symptoms of intermittent ation often do not worsen ne. jrmittent claudication does ow itself when a person is inactive. But the condition can make it painful to walk a block, or even a half block, without resting. The ailment can interfere with activities of ordinary living, such as walking the aisles of a super market. “It’s like having a plugged fuel line in a car,” Dawson said. “You can idle OK, but when you step .on the gas, it sputters and stalls.” Clogs in the arteries reduce the ability of oxygen-carrying red blood cells to move to muscle cells. Exercise makes muscles more effi cient in using the oxygen they can get. Dawson is coauthor of an arti cle in the journal Pharmacy and Therapeutics, which recommends exercise and drugs as a first-line therapy before doctors consider medical procedures to widen or replace damaged blood vessels. In the treatment options outlined in the paper, only patients with pain at rest - a sign of extensive artery problems - would be referred directly to a vascular surgeon. Vascular surgeons also see the value of trying exercise first. A treadmill program can double or triple the time or distance a patient can walk, said Dr. William R. Hiatt of the University of Colorado Health Sciences Center in Denver. An intermittent claudication patient may start the course of treatment at a very slow pace of 1 mile per hour, and wind up as fast as 3 miles an hour, which would count as a minimum brisk walk for a healthy person, Hiatt said. The training program requires working into the point of pain and resting, repetitively, for up to 50 minutes. In his studies, 90 percent of people who start a three-month program stay with it until the end, Hiatt said. Others in less-well-mon itored programs would probably do less well, he said. Exercise has to be part of a Device reduces impotency risk THE ASSOCIATED PRESS Exercise makes muscles more efficient in using the oxygen they can get. monitored program, Hiatt said. “If you just tell a patient to go out and walk, it doesn’t happen,” he said. The pain puts off the unsupervised patients, he said. Drugs can also fight intermit tent claudication. Dawson and other researchers found that patients given a new drug, Pletal, increased their pain-free walking distance by 58 percent. The drug seems to help the arteries widen, he said. “But it doesn’t work for everybody - prob ably about half - and it takes weeks to months for the effect to be seen, he said. More aggressive treatments than exercise have their place, said Dr. Gary J. Becker, assistant med ical director for the Miami Cardiac and Vascular Institute. “Intermittent claudication, when it is early and mild, tends to respond nicely to a monitored exer cise program,” Becker said. As with other peripheral vascular prob lems, the patients also have to not smoke, and to control their choles terol and blood pressure, he said. Medical procedures are a logi cal next step for those in whom lifestyle changes have not worked and who still want active lives, such as letter carriers whose jobs depend on walking or exercisers who want to continue their sports, Becker said. One option is a balloon aiigio- plasty, in which a tiny balloon is threaded through an artery and expanded. Another is an artery bypass operation. But Becker said people who won’t give up smoking, for example, are not good candi dates for these more aggressive treatments. CHARLESTON, S.C. There is less risk of impotence after surgery for prostate cancer with a new device that allows doctors to save the right nerves. The device helps a surgeon locate the two nearly invisible nerves entwined with blood ves sels and tissue that cause erec tion so they can be avoided when cutting away a cancerous tumor. “Studies, so far, have very good results,” said Dr. Gerald Hull,' assistant urology professor at the Medical University of South Carolina. Hull said the technology is too new to know what the long term results will be - it is used at just 17 medical centers nation wide “ but he sees a “potentially great benefit.” The new technique should encourage men to be screened for prostate cancer, which is highly curable if treated early, but still is the second leading cause of death in men nation wide. The numbers are especially disturbing among African Amer ican men. The disease is the most common form of cancer in black men. Eighteen percent of cancer deaths among black men are a result of prostate cancer. “What most men worry about is, ‘I’m going to be impotent.’ That scares them from having any surgery,” said Bob Strobel, who talks with men at a prostate cancer support group in Charleston. “It scares men away from being diagnosed and test ed.” Prostate cancer surgery can stretch or sever the nerves that cause erection and it could take longer than six months for a patient to heal and know whether he would regain normal function. Now, Hull said he can test the nerves with the device immedi ately to determine whether they work. The device is most successful with relatively young, healthy, potent men who are in the early stages of cancer, Hull said. Surgery is meant to cure cancer; therefore sparing nerves in advanced cancer cases is not a top priority, he said. If a patient is younger than 60 and has full function before surgery, he has about a 70 per cent chance of full recovery to perform sexually if both nerves are spared and just 30 percent if one nerve is spared, Hull said. The success rate decreases with age, Hull said. A man older than 65 with normal function has a 50 percent chance of achieving normal erections if both nerves are spared, he said. Nerve grafts are another alternative to save a man’s poten cy after surgery, Hull said. Nerves can be harvested from a patient’s leg and grafted into place. The nerve device can then be used to test whether the nerves work. A wand or probe attached to the device has finger-like exten sions and eight electrodes. On contact, a low volt of electricity excites the nerve and lights up a monitoring screen. Prostate cancer treatments also include radiation, seed implants, hormone therapy and possibly chemotherapy. I expected judgement and criticism. I found sensitivity and love. 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