Ask Us Anything About… Vascular Disease

Scott Gilbert – From Penn State Health, this is Ask Us Anything About Vascular Disease. I’m Scott Gilbert. We’ve all got two main types of blood vessels. Arteries, which carry blood away from the heart and veins, which carry blood back to the heart. Any of a number of conditions that affect the circulatory system are called vascular disease. This includes diseases of your arteries, veins, and lymph vessels as well as [inaudible] that affect circulation. A lot of ground to cover here, but we’re going to learn more today from Dr. Ali Amin, Board Certified Vascular Surgeon, with more than three decades of experience treating vascular disease. He recently joined the staff at Penn State Health St. Joseph. Dr. Amin, welcome to this interview, and I’d like to say welcome back to St. Joe’s.

Dr. Ali Amin – Thank you, Scott. Great to be here in our program and, yes, so I’ve been in Berks County since 1995 taking care of various vascular diseases in Berks County patients. And I left the hospital in 2005, went to Tower Health in Reading. I’m excited to be back at St. Joe Penn State to provide the best vascular service to this community.

Scott Gilbert – And we’re thrilled to have you back. Dr. Amin I want to start with the general definition of vascular disease. When we throw those words out there, we’re really talking about any condition that affects your blood vessels. So I guess by nature it’s a broad term. Like I said, we’ll cover a lot of ground, talk about a lot of things. But what are some of the most common diseases in this category? Can you give folks an idea of what we’ll be talking about here?

Dr. Ali Amin – Sure, Scott. So the circulatory system allows the blood to leave the heart and come back to the heart. There are essentially three components to it. The arteries that take the blood away from the heart, which is good blood if you will. They’re oxygenated with nutrition that takes it to the muscles and to the organs. There are veins that are taking the blood back to the heart. These are ones if you think about dirty blood that has been used by the muscles and the organs. That they go back to the heart and to some lesser components, the lymphatics, which is just clear fluid and tissue fluid. But for the most part, there are arteries and veins that are involved in the body. And we talk about vascular disease. Generally we either have to separate it, is it the artery, or is it the vein? And so identification of which category is important. In terms of the arteries, generally speaking, there are two kinds of abnormalities. One is build-up of plaque or atherosclerosis or hardening of the arteries if you will. What happens is that over a period of time, the cholesterol plaques build up in the blood vessels and causes a narrowing ultimately, maybe an occlusion and cause end organ damage. And the other one is called aneurysmal disease where you get a ballooning of the blood vessel where the blood vessel gets dilated, becomes a balloon and then it can rupture and cause, you know, there’s a risk of death with that. So those are the two for the arteries. In terms of the veins. Again, the veins, remember, take the blood back to the heart. We can have blood clots in those veins. We call those deep vein thrombosis. They mostly involve the legs. And then the second category that more people are familiar with are varicose vein disease. And the varicose vein disease more commonly occurs in females than males. Obviously, you can see the varicose veins in your leg. It’s sort of a ropey, dilated veins underneath the skin, of various sizes. And usually there are risk factors associated with that.

Scott Gilbert – So like we said, a lot of different disorders here. We’ll try to get to as much of it as we can. If we hit on a topic that’s of interest to you or there’s anything you want to know from Dr. Amin, please feel free to put your question or comment in the comment field below this Facebook post. And we’ll get to it whether you’re watching this video live or if you’re watching it at a later time, we can answer your question with a text response. So you mentioned blockage and you mentioned cholesterol. So we hear a lot about how cholesterol is bad for you, but I guess this is how that manifest, right? Where it can turn into an arterial blockage, and obviously, if arteries can’t do their job, that’s not a good thing.

Dr. Ali Amin – That’s correct. So what happens is, and again, when you talk about the blockage, the blockage is the same in all the blood vessels. So if it happens in the blood vessels in the neck, it affects your brain, you can get a stroke. If the blood vessels are blocked off in your heart, you can get a heart attack. If the blood vessels are blocked off to your legs, then you can get pain when walking. You can get what we call rest pain where you have pain at rest. Or you can have an ulcer or gangrene. You can have a blockage to your kidneys that can cause your blood pressure to go up. So it depends on which, if you will, which section of your body is the blockage affecting. And so in terms of the risk factors for this blockage, are mostly — there are probably the two most important ones that everybody should know — smoking and diabetes are the two most important ones. And unfortunately, you know, once you have diabetes, you really do too much about it. But the most important with diabetes is to make sure you take your medication and make sure your glucose level is controlled. That’s the best you can do and that will minimize formation of a blockage. Smoking is probably the worst thing that you can do to your body. It damages the lining of the blood vessels and it causes blood clots or blockages to form. And if somebody who’s diabetic and smokes, that’s like putting kerosene on a fire, which is the worst thing you can do to your body. In addition to those, I would say high blood pressure, high cholesterol, and obesity, and a family history are the risk factors that everybody should know about. Again, make sure your blood pressure is checked on a frequent basis. Make sure you try to stay active, to lose weight because obesity is associated with that. There’s not much you can do about family history, but if you know you have a bad family history then you want to make sure that everything is in the best shape it is.

Scott Gilbert – So one of those health tips that we share for other illnesses, exercise, eating right, a wide range of things, really also contribute to the health of your arteries and your veins as well. So that’s a really important takeaway here. Again, we welcome your questions for Dr. Ali Amin. He is a vascular surgeon at Penn State Health St. Joseph. We welcome your questions in the comment field here for Ask Us Anything About Vascular Disease. You had mentioned aneurysms before. I’d like to get into that a little bit because that can be a scary word, right? We’re talking about part of a blood vessel that forms a kind of a bolus, so a little bit of balloon that could end up hurting you. [multiple speakers] Right. So tell us a bit about what causes an aneurysm. Do we know what causes them, and do people always know when they actually have an aneurysm?

Dr. Ali Amin – Scott, that’s a great question because most people do not know they have an aneurysm. Aneurysm, again, is a ballooning of the wall of a blood vessel. When the wall of the blood vessel becomes weak, then every time the heart pumps, it can become dilated. So think about it as a balloon and you breathing into the balloon and the balloon gets bigger and bigger and at some point it’s going to pop, right, because it cannot hold on anymore. So most patients do not know they have an aneurysm. If the aneurysm occurs in your brain, you can have a stroke. If it happens in your abdomen, it can kill you if it bust open. So the things to look for, number one is family history. If you have a history of a brother or a father or a family member has died from the aneurysm or had an aneurysm, that’s something you should tell your family doctor. And the second risk factor is blood pressure. Your high blood pressure can cause aneurysm formation. So family history of aneurysm in the family and high blood pressure. And if you do have an aneurysm, then the most important thing is to make sure your blood pressure is under control. Unfortunately, unless you do some kind of testing, you don’t know you have an aneurysm. So normally we do an ultrasound of the abdomen to look to see if you have an aneurysm in your belly. Sometimes, you know, if your aneurysm needs to be measured more precisely, then we do a CAT scan to look at that aneurysm. And, you know, these days, in the old days, we used to have to cut you from stem to stern to fix this aneurysm. Now we can try to fix those aneurysms without any cutting of your belly and most of the time, we can just make little tiny holes in your skin in your groin and fixing those aneurysms.

Scott Gilbert – Through a catheterize I suppose then, right?

Dr. Ali Amin – That’s correct. So we call that endovascular intervention where we essentially exclude the aneurysm from the body, and the patient goes home in 24 hours. In the old days, they used to stay in the hospital for a week.

Scott Gilbert – Is it possible that some people don’t know they have an aneurysm until it burst and something bad happens?

Dr. Ali Amin – Until it burst or more commonly these days, you know, patients have abdominal pain or abdominal discomfort for various reasons. For example, you might have an abdominal pain because you have a gallbladder problem, or you might have a hernia, or you might just go to a doctor or emergency room and they can order a CAT scan to see what’s going on in your belly. And all of a sudden they see this aneurysm, and the aneurysm is not really causing your belly pain because something else is causing it. But they find out — we call that a coincident that you have an aneurysm. And then based on that, then you are followed up with a doctor on a frequent basis. So for example, if the aneurysm is three centimeters, that’s a very small aneurysm. A five-centimeter aneurysm is the size that we think about fixing the aneurysm, generally speaking. Or if the aneurysm gets bigger. So not all aneurysms need to be repair. It depends on their size. But once you know you have an aneurysm then the patient is sent to a vascular surgeon such as me, and we set up those patients to see if they need to have a repair done. If the aneurysm is small, then it doesn’t need to be repaired, we say the same thing. Make sure your blood pressure is good, make sure you keep an eye on it and then we see those patients back anywhere between three months or six months or one year. They need an ultrasound to make sure that the aneurysm hasn’t got any bigger so we can check on it.

Scott Gilbert – And the key being to keep an eye on it. Let’s switch from arterial disorder to a venous disorder. That is varicose veins. It’s something that I would think is very common. I think we all know people who have this disorder. What exactly causes varicose veins, Dr. Amin? What’s happening inside the body that’s causing that painful and it’s kind of an unsightly condition too?

Dr. Ali Amin – Yes, so the varicose veins are two types. They are, as you mentioned Scott, the one type is just unsightly. They don’t really bother you. But for the most part, they do bother you. They have a variety of symptoms, pain, swelling, aching. They can cause numbness, tiredness, especially if you’re a very active person, you can see that the aching gets worse when you have activity. It’s more common in females than males, and the most common cause of varicose veins is unfortunately genetic. So if a female has a history of varicose veins in the mother or grandparents, then it’s going to be more common. The other risk factor is pregnancy. With pregnancy, the risk of developing varicose veins goes up. The reason for that is that as you get pregnant, your total body fluid increases, and guess what? Gravity always wins. And so you get leg swelling, leg edema, and then that damages the valves of the veins, and then you start the progression of forming varicose veins. So when I see patients who have varicose veins or any patient that was pregnant and even doesn’t have varicose veins, I tell those patients or friends or family to make sure they wear support stockings during pregnancy so it doesn’t cause varicose veins [inaudible]. But for the most part, it’s genetic, family oriented. Again, males also have it, but again, we have various treatments for those and a lot of them are minimally invasive.

Scott Gilbert – And what are the indications for maybe just living with varicose veins? Do you ever see a patient who maybe it’s not really impacting their life, and you say, you know, for now you’re okay to live with them, or do you usually recommend having them remedied?

Dr. Ali Amin – Yes, so if they don’t have symptoms at all — a lot of times they don’t realize they have symptoms until they start telling you what they have. You know, hey, my legs get tired, I have achiness. They think it’s something else, but actually it’s the varicose veins or the leaky veins doing it. So that’s why it’s important to see a specialist, number one. Number two, if they have essentially no symptoms at all, they can live with varicose veins. My suggestion is to wear support stockings to minimize those veins from getting bigger. But for the most part, they can just keep an eye on them. And then you have the third group that says, listen, I have no pain, I have no achiness, it just looks bad. Would you take care of it? Of course that becomes a cosmetic procedure and then we’ll have a discussion with the patient, what’s the best way to do that.

Scott Gilbert – You’re watching Ask Us Anything About Vascular Disease from Penn State Health. I’m Scott Gilbert alongside Dr. Ali Amin. He’s a vascular surgeon at Penn State Health St. Joseph. And we welcome your questions for Dr. Amin. So feel free to put them in the comment field below this Facebook post, and we will pose them to him. Whether it’s about aneurysms or vascular, any type of vascular disease. Now he’s the guy to ask. So while we have him on the line here, let’s go ahead and get a few questions out there for him. I would like to pivot to peripheral artery disease. You know there are a couple different types of arteries, right? There are the type that are part of the heart and then any artery that’s outside the heart is a peripheral artery, if I understand it correctly. Can you talk about what peripheral arterial disease is?

Dr. Ali Amin – Sure, Scott. So as you mentioned peripheral arterial disease is any blood vessel that is outside the heart. So they involve the blood vessels that go out to the neck perfusing the brain. And they involve the blood vessels that go out from the heart to your arm and to your hand that perfuses the upper extremity. And also goes down to your kidneys, provides blood flow to the kidneys, provides blood flow to your bowel and guts, provides blood flow to your legs. So any kind of narrowing or blockage that affects the blood flow to your organs is going to cause you to have problems. For example, let’s just pick carotid for the first one. If you have a blockage of the neck, it affects the blood flow to the brain. You can have a mini stroke. What are the signs of a mini stroke? Again, you can have weakness of the hand or the arm, whether that the left side of the brain controls the right arm. So it’s always the opposite and vice versa. So you can have weakness of the arm, numbness of the arm, weakness of the leg, numbness of the leg. You can have difficult with speech. You can have trouble with the vision, like a shade coming down, like a curtain coming down. And the reason we call it a mini stroke is because they only last a few minutes and goes away. And if that’s something that you’ve never had before, you should contact your provider as soon as possible. The other one is a stroke, which is a permanent problem where there is a deficit such as the patient is unable to use their right hand or the left hand or leg, and that’s when the damage to the brain occurs permanently. And then you have to have rehabilitation to get better. If you have a blockage of the blood vessel that goes to your leg, there could be a couple of different scenarios. The first scenario is you will have trouble walking. You walk maybe for one block or two blocks and your legs get tired, and then you realize that this happens exactly the same every time you walk. So for example, people say, oh, I have pain. Well do you have pain all the time? No, sometimes I have pain. Well if you have a blockage causing poor circulation, it’s going to happen every time when you walk. So for example, every time you go get your mail from the mailbox, which might be a block away for somebody, or if they go shopping. Hey, I can walk two blocks. So if it’s poor circulation, it’s going to be consistently the same amount of distance that you walk, and it will happen all the time. The reason it happens all the time is because you don’t have one day blockage and another no blockage. So remember, there’s many reasons to have leg pain besides having poor circulation. If the blockage continues to get worse, then you’re going to have pain at rest. So you’re sitting around, you’re sleeping, you have pain in her leg and report that’s constant because the blockage now is worse than it was before. And then if you just let it go, then you can get an ulcer and gangrene, which is soreness of the foot or the toe or it can turn black. We call that a gangrene. So, again, if you’re diabetic, that’s even worse because of lot of patients, a lot of diabetics, they have what we call neuropathy. They have numbness of the feet and toes. They don’t feel it. If they walk barefoot, they might step on it. So you a nick in the skin, you get an ulcer, you get a gangrene, then a foot infection. So it’s very important again for those patients that maybe we’ll talk about lifestyle changes that you would be very careful if you’re diabetic when you’re walking.

Scott Gilbert – Yea, and so obviously peripheral arterial disease covers a lot of different things. A couple of follow-up questions for you. When I’m thinking about, you know, somebody who has a pain in their leg, are those often mistaken for muscle disorders, nerve disorders, that type of thing? I mean, is a vein or artery disorder up high on somebody’s list?

Dr. Ali Amin – Yea, so that’s a great question because it can be mistaken for other etiologies. So for example, most of our patients — again, we talk about arterial disease or blockage in the blood vessels — most of our patients are in older age groups, 60s and 70s and 80s. So remember it take time for the plaque to build up unless you’re a smoker. If you’re a smoker, then you present at an earlier age. I’ve seen smokers present with poor circulation to the legs as young as 30s because smoking really damages the lining of the blood vessels and can affect you. So it can be mistaken for — for example, patients might have pain in the thigh or hip and actually they might have poor circulation, but actually they might think that they have some kind of joint disease. So it’s important to talk to your doctor and be examined by your doctor to see if in fact your pain is consistent with peripheral arterial disease or poor circulation. For the most part, if you do have pain with walking, the pain occurs in the calf muscles. So it is not in the knee joint, but in the calf muscles. If it’s in the knee joint, that’s mostly like arthritis or something. The more important thing is when you go to see your family doctor, explain to them in detail where is the pain, how is the pain, what makes the pain worse, and what makes the pain better, and your doctor is able to analyze your diagnosis.

Scott Gilbert – Now when it comes to carotid artery disease, you mentioned if there’s a blockage here in the carotid arteries, that can lead to a stroke depending on which side it’s on, what affects, you know, certain parts of the body. Are there signs of problems with your carotid arteries short of a stroke or even a mini stroke? That is, you know, are there ways to possibly flag an issue of your carotid arteries before it leads to something that severe?

Dr. Ali Amin – Another great question, Scott. Unfortunately, there is not, so most of the patients do not have a mini stroke to go have a full stroke. Unfortunately, the full stroke can occur suddenly and your left with you can’t talk or you can’t move. If you’re lucky, you will have signs of mini stroke, the things that I talk about. You might have weakness, numbness of the arm or the leg or difficulty with speech or visual changes that only last a few minutes. And if you get that it is important to contact the family doctor. Don’t let it go away, to make sure that you didn’t have a mini stroke. People say, oh, you know, it’s only [inaudible], it’s probably nothing, let it go, but contact your physician even though you’re back to normal just to see what was so you can be examined. The other thing is when you go to the family doctor, the family doctor could set a stethoscope on your neck to listen to your neck. And if he hears a noise, we call that a bruit, then we order an ultrasound to see if there are any blockages around your neck. So we can do the ultrasound of your blood vessels in your neck to find if there are blockages. And even if you have no symptoms, that can be one way to find out if these narrowings are significant enough to be treated. And we have a wide variety of tools to treat that. We can treat it with open surgery, we can treat it with a stent, we can treat it minimally invasive. We tailor that according to each patient.

Scott Gilbert – You’re watching Ask Us Anything About Vascular Disease from Penn State Health. Dr. Ali Amin is a vascular surgeon at Penn State Health St. Joseph. And he welcomes your questions. So feel free to add them in the comment field whether you’re watching this video live or at a later date. We will be sure to get you answers because we’re covering a lot of ground here. I want to make sure that we answer your questions as well. You know Dr. Amin, you mentioned earlier that disorders of the lymphatic systems are less common. But let’s talk about those briefly because we do hear about things like lymph nodes and lymph vessels when we talk about cancer and things like that. But what exactly are lymph vessels and lymph nodes, and what are some of the things that can go wrong there.

Dr. Ali Amin – Yea, so the lymphatics are the least common ones. The lymph vessels are channels like blood vessels. They’re much thinner and less pronounced in the body that essentially take the fluid, clear fluid, back to the heart. And if you have for example, God forbid if you had a mastectomy done where, you know, they take the lymph nodes out from the area of the axilla, that prevents the fluid going from up your arm, and you’re going to get a swelling that can be depending on how much extensive surgery you had. You can also have inflammation of the lymph nodes and lymph vessels in the leg, so you can get what we call lymphedema. So it’s actually the edema that is caused by the lymph problem. And those things we usually take care of by sending you to a specialized area at Penn State St. Joe where you are provided with support stockings or compression pumps that helps you essentially milk those fluids out of your leg. So those are the least common ones, but for the most part, if you have some kind of edema, it could be from your heart. It could be from fluid overload. Salt intake, you’d be surprised how many people on Monday they have swelling of the legs because after the football game, they were sitting having nachos and a lot of chips that were salted, and drinking a lot of fluids. So again, with support stockings you can try to decrease the swelling in both legs.

Scott Gilbert – We need to walk around when we eat those nachos. Duly noted. You know you [multiple speakers] [laughter] — that works too. You mentioned earlier that some disorders like varicose veins are largely determined by genetic factors. But also as we talked about earlier, there are a lot of vascular diseases that you can reduce your risks due to lifestyle changes. So let’s talk about some of those because we talked about being overweight, not getting enough exercise, smoking, as being risk factors. So the flip side of those are lifestyle changes that can really reduce your risks, right?

Dr. Ali Amin – Absolutely. I cannot over-emphasize, you know, most of us, you know, people think that I’m going to go to a doctor and get a pill and the pill’s going to make me improve. I have to admit I’m the last person to take any medicine. And one of the things we can do each day is number one, have a healthy lifestyle. And essentially that falls into two parts. One is diet and number two is exercise. But when it comes to diet, I don’t mean that you have to become — you know, eating celery sticks every day of the week. I’m talking about having a healthy diet that is comprised of say fish, chicken, or even meat, but decrease your red meat intake. At the same time be going fish and chicken. Try to sauté them, grill them. Grilling is amazing because all the fat comes out. Again, instead of having carbohydrate, mashed potatoes, have your favorite vegetables with that. We can essentially use corn, you can use zucchini, eggplant, whatever your vegetable is, you can put it as a side dish instead of having a starchy side. And again, what you want to do is you want to stay away from carbohydrates and sugar. Sugar is probably your biggest enemy. People think that hey, I’m going to buy low fat or no fat, that’s a good thing. Well, actually that’s a misnomer because if you look at the sugar content of every product, especially the low fat and no fat, the sugar content is higher because they have to make it taste good for you to take it. And it is the sugar that actually is converted into fat. So when you go out there, look at the sugar content. If you’re drinking soda and you want to keep drinking soda — you say, I’m not going to stop drinking soda, then go to a diet soda or zero soda that they talk about. You know, if you look at a can of Coke, there’s always 30 grams of sugar, and it’s crazy the amount of sugar in a can of soda. So that sugar gets converted to fat. So stay away from sugar and try to have a variety of meals throughout the day, grilling, sautéing, broiling fish and chicken. And then when it comes to exercise, I don’t mean you have to run a marathon or run every day. Believe it or not walking is a great exercise. But, you know, if you have joint problems, you can go for a long walk. If you cannot walk, get a stationary bike. You’ll be surprised that any kind of muscle activity is exercise. And walking and a stationary bike are the two best ones. If everything else fails, and I know there’s COVID now, people don’t want to go to the gym, but if want to go to the gym and the gyms are pretty cheap now. Ten bucks a month you can go and join a gym and exercise. You know, nobody’s there early in the morning and late at night. So staying active means a lot to your body.

Scott Gilbert – And specific to your arteries and veins, what does that do. This might even be kind of an obvious question, but I mean, is it the matter of you being active and the blood is pumping through your body with a little more purpose, and you’re kind of, you know, making sure that it reaches all your extremities? That kind of thing. I’m just wondering what’s happening physiologically when you exercise that’s good for your arteries and veins?

Dr. Ali Amin – So not just your arteries, but also your heart. Your heart becomes trained and becomes more user friendly, if you will. You know what I’m saying? So when you do that, there’s a lot of that in the neurologic response of exercise. Your immune response improves when you exercise. So your defense mechanism improves. Your blood vessels will get bigger in terms of providing more nutrition to your muscles. You heart becomes more trained. So it’s a global phenomenon throughout your body by doing some exercise a few days a week.

Scott Gilbert – And I’d like to end with a fun fact. You can tell me if it’s true. I saw it on the Internet. If your entire network of blood vessels were stretched end-to-end, they could circle the earth multiple times. Is that true?

Dr. Ali Amin – That is absolutely true. And a lot of people who have blockages in their blood vessels, one of the things we do is that when we see these people in the office, you don’t jump into your procedures on them, whether it’s an open surgery or a minimally invasive procedure. One of the things I like to do is to put them on an exercise program, starting a specific exercise at Penn State St. Joe geared toward this. And believe it or not, you’d be surprised that after three months of supervised exercise that we tailor for you, that you’re blood vessels are big enough that those blockages become a mute point.

Scott Gilbert – Good to know. Well, great, Dr. Ali Amin. Thanks so much for your time today. It’s been great getting to know you and great learning from you all about vascular disease. So thanks for your time and we’ll make sure that we put a link in the comment section here below this Facebook post so people know how they can get in touch with you and your office. So if they have some questions, maybe they’re experiencing some of the symptoms we talked about and they want to get checked out. We’ll make sure they know how to do that. So Dr. Amin, thank you again for your time today.

Dr. Ali Amin – Thank you Scott. It was a pleasure to be here. Thank you.

Scott Gilbert – And thanks to everybody who tuned in today for Ask Us Anything About Vascular Disease from Penn State Health St. Joseph.