The educational process for the patients begins with understanding the disease and its risk factors. The patient and healthcare provider should discuss the short and long term expectations for management of the patient’s condition. These should be clearly defined, including both the changes the patient will have to make and the anticipated outcomes from those changes. Realistic expectations and an understanding of the importance of a treatment plan are crucial for the patient’s compliance to treatment for their disease. High motivation to make changes can help the patient to feel less deprived of certain lifestyle habits or activities, because the patient is focused on the long term goal of PAD management; primary and secondary prevention of related complications.
Coping Strategies
Medication management was a strategy used by all patients to alleviate their symptoms and prevent CVD events. Due to the symptomatic nature of PAD, medication was often perceived as a means to an end in which symptoms could be controlled, allowing patients to maintain their current lifestyle. The use of aspirin and/or statins for cardiovascular event prevention was considered to be essential by all patients. Patients who were prescribed medication for claudication were often unaware of the intended purpose of the medication, and its perceived benefit was quite low. This lack of information often led to experimentation with the type and dosage of medication, and a number of patients expressed frustration at the lack of a definitive medical treatment for claudication. Despite this, many patients felt that medication management was a useful strategy, particularly when it was combined with other treatments. High adherence to medication was often related to the severity of the patient’s symptoms and the impact of PAD on their life.
Whenever patients encounter and are diagnosed with a chronic illness, coping becomes an essential aspect of their treatment. This section explores the coping strategies patients used to deal with their PAD. Lifestyle modifications emerged as a key strategy to minimize the impact of PAD. Taking greater control of their condition, patients used information provided by medical staff, the internet, and PAD literature to develop a better understanding of their illness. Using this knowledge, patients reconstructed their daily routines and activities to accommodate their condition and prevent symptom exacerbation. This included moderating activity levels, ensuring rest intervals during walking, and avoiding activities likely to cause pain or discomfort. Exercise is considered to be a valuable tool in preventing symptom exacerbation; however, patients found it difficult to implement due to the pain experienced and their uncertainty regarding the safety of exercise on their condition. This prompted many patients to seek professional advice from medical staff and supervised exercise programs. A small number of patients were forced into early retirement or had to change their occupation due to the physical limitations of PAD. This had a mixed acceptance as some patients felt a sense of relief while others felt frustrated and defeated. Finally, patients changed their dietary habits, often resulting in weight loss and a healthier lifestyle. Overall, lifestyle modifications provided patients with a sense of control and the possibility of symptom improvement.
Lifestyle Modifications
An important dietary consideration for people with PAD, and intermittent claudication in particular, is to increase the amount of complex carbohydrates that are eaten each day. Complex carbohydrates are found in foods such as bread, cereal, rice, pasta, and starchy vegetables. They are the best energy source for people with claudication because they cause less of a rise in insulin levels and are less likely to be stored as fat. On the other hand, simple sugars and fat can worsen the symptoms of claudication. Simple sugars cause a rapid rise in insulin and can be converted to fat stored in muscle cells. High insulin levels and fatty build-up both make PAD symptoms worse. Therefore, it is best to limit the intake of simple sugars and fat.
Lifestyle modifications have the potential to make a significant impact on the course of PAD. Patients need to stop smoking and using tobacco products. They should also start a program of exercise, such as walking, that can be done regularly – even if they do not have symptoms of intermittent claudication. It is also important to control other risk factors, such as diabetes, high blood pressure, and high cholesterol. This may require a visit to a primary care provider for medical management of these conditions. A healthy diet can also help to control these risk factors and can also contribute to weight loss, which would further reduce symptoms.
Medication Management
Many patients take medications to control risk factors for atherosclerosis and to improve intermittent claudication. These risk factors include high blood pressure, diabetes, high cholesterol, and smoking. It is essential to control these risk factors to stop the progression of PAD. High blood pressure is usually treated with a diuretic, a beta-blocker, or an ACE inhibitor. Diabetes that has affected the kidneys may require blood pressure medications and/or insulin to control blood sugar. High cholesterol is treated with diet modification and medications such as HMG-CoA reductase inhibitors (statins), niacin, fibric acid derivatives, bile acid sequestrants, and cholesterol absorption inhibitors. Smoking is controlled by a nicotine patch/gum or an oral medication such as bupropion (Zyban) or varenicline (Chantix). Both diabetics with protein in their urine and patients with intermittent claudication may benefit from medications that block angiotensin II, such as an ACE inhibitor.
Long-term or ongoing illnesses, such as peripheral arterial disease, generally require medications to control symptoms and to modify or stop the progression of the disease process. The major burden of remembering which medications to take and when to take them falls on the patient and can be overwhelming, but it is also essential for success. A daily pill box or a chart that is marked off each time a dose is taken can be very helpful. It is important that patients understand the medications they are taking, such as the name and what it is supposed to do. They should ask the prescribing physician to write that information down for them. Patients should always know the dosage of the medication and how the dosage may change over time.
Pain Management Techniques
Peripheral artery disease (PAD) patients commonly experience chronic pain, and thus it is imperative that they find effective ways to manage their pain.
Pain can be acute or chronic. Acute pain provides an identifiable cause and can be expected to last for a short period of time, for example, surgical pain or trauma. Chronic pain is pain that persists beyond the expected time for healing. It is an ongoing or recurrent pain that can last for years.
Pain can outlast the duration of the original injury or disease and often takes on a life of its own. This can result in changes in the central nervous system, which may increase the sensitivity of the nerves. This means that the nerves can begin to send pain signals to the brain in the absence of any recent injury.
The physical aspect of pain results from nerve stimulation. The injured tissue sends a signal through the nerve roots to the brain for interpretation. The emotional aspect of pain can affect the severity and duration of the pain. Emotions such as anxiety and depression have been associated with chronic pain and can amplify the perception of pain.
Pain is the most common reason people seek medical attention. But what is pain? Why does it occur and what can be done about it? We all experience pain in different ways, whether it is a headache or a stubbed toe, the outcome is usually the same. Pain is an unpleasant sensation that can range from mild, localized discomfort to agony. It has both physical and emotional aspects.
Support Systems
Finally, a number of our respondents who are dealing with advanced PAD expressed the knowledge that their condition has already or will soon become a burden to family members and they are making plans for placement in an assisted living facility. This knowledge can sometimes help the patient to feel that they are doing the responsible thing by sparing their family from the burden of caregiving.
A common solution for those who find themselves in the position of being a caregiver to a loved one with PAD is seeking outside assistance. Paid professionals can come into the home and assist with daily care.
Most people mentioned the importance of having a supportive spouse or partner in dealing with the changes thrust upon them by PAD. A primary caregiver is often either a spouse or an adult child. One older man talks about how much it meant to him to have his wife caring for him over the 5 years following his diagnosis and treatment for PAD.
Without support from others, adapting to living with PAD can be an even more difficult experience. We have obtained comments from our survey respondents on effective ways of coping with support.
Family and Friends
In order to provide the best possible support, it is essential that family and friends understand the impact of PAD and the needs of the patient. This can occur through communication with the patient, as well as reading about the disease and its management. Family members may often play an advocacy role for the patient, making sure that the patient receives appropriate treatment and is able to access the necessary healthcare services. This is an active process that may involve considerable time, effort, and persistence and may be less stressful and frustrating for partners living, dealing with, and supporting each other.
PAD has been shown to be a major health issue in terms of prevalence and economic burden. With the aging of the population, the proportion of people with PAD is likely to increase even further, with implications for public health and healthcare services. Social costs relating to informal care, inability to work, and reduced mobility are likely to be substantial. Family and friends will thus play an increasingly important role in providing support for PAD patients, particularly as healthcare resources become more limited.
Despite being a major cause of morbidity and mortality, PAD has received little attention from researchers. In comparison to other cardiovascular diseases, there is a paucity of epidemiological data about the true magnitude of lower extremity revascularization procedures and their outcomes.
Patients with chronic disease often rely on family and friends as essential sources of support. Family members and friends can often be the most constant and reliable sources of support, as they may be present to help the patient on a day-to-day basis, as well as at times of need. This can be particularly important for patients with PAD, who often face not only physical limitations because of their disease, but also psychological distress and reduced quality of life.
Support Groups
A support group is an association of people who share the peripheral arterial disease condition. The key functions of a well-run PAD support group are to exchange information and to provide psychosocial support for patients and their families. Participants would benefit from hearing how others have coped with this condition, what treatments have worked, and what lifestyle changes have been successful in improving comfort. Patients with intermittent claudication, who are considering medical intervention, might find it especially helpful to talk to those who have gone through similar procedures. And people faced with the decision about whether to undergo an amputation need to talk to those who have made this choice. Information exchange at support groups can fill gaps left by the healthcare providers’ office visit. Patients often need reinforcement about explanations or instructions given during a 10 to 15-minute office visit. And finally, patients with chronic diseases such as PAD have a lifelong task of managing their health condition. This will involve successive coping adaptations as lower limb symptoms progress over time and as other health issues arise. Success at each of these coping stages will depend upon how well the patient has understood their condition and the possibilities for alleviating symptoms. Support group discussion would be helpful at each of these coping steps.
Healthcare Professionals
This undertook a qualitative study using ten registered nurses who had been recruited from five different healthcare sectors around New Zealand. This was done to gain an understanding of how prevalent PAD care management was amongst various healthcare settings, and to explore the beliefs and opinions of registered general nurses on their role in PAD care management. By gaining an understanding of the beliefs and opinions of the nurses, it was to assist us in understanding the role of the nurse in patient care management so they can seek to aid understanding and awareness of PAD, and improve clinical practice for the patient’s benefit. The qualitative approach was seen as most beneficial as there had been little previous research on the subject so it allowed us to get the necessary knowledge and understandings about the topic from the healthcare professionals’ perspective, and use this as a foundation for further exploration of PAD care management by healthcare professionals.
The goal of the healthcare professional is to provide the patient with the very best quality of care, ensuring all patients receive satisfactory, professional and efficient treatment. They aim to do this by educating the patient, to enable them to understand their condition and in turn to manage it effectively in order to reduce symptoms and progression of PAD. They will also help to reduce cardiovascular risk factors and improve the patient’s quality of life. To explain the role of the healthcare professional in more detail, comments were sought from healthcare professionals based in primary and secondary care. Using the information collected, important goals of the healthcare professional have been identified.
