As Gale Fisher approached her late 60's in Northern California she remained an active woman who loved to play golf and walk. But pain in her right calf made walking very far difficult. And it was getting worse. Gale eventually saw her doctor and had an x-ray of her spine. One eminent doctor thought her pain was caused by stenosis, narrowing of her spine. He suggested fusion surgery might be needed.
Gale knew back surgery all too often does not relieve a patient's pain so she opted for a more conservative approach ' injections. She also tried physical therapy. Neither approach worked. She was depressed as her mobility became more limited and she hesitated to move forward with surgery.
Then her husband got a new business assignment in Seattle and the couple moved. Gale decided it was a chance to get a second opinion. The Seattle spine surgeon didn't think stenosis was the problem. He suggested shots for pain relief again. And again, no relief.
Joining the ranks of 'powerful patients' Gale went on the Internet and typed in the Google search box: 'What are all the causes of pain when walking?' You can imagine how many sites Google came up with! Nevertheless, Gale plowed through them and came across a word she had never seen before nor heard from any doctor: 'claudication.' It comes from the Greek word that means 'to limp.' And in medical terms it means an artery is blocked to the leg.
You will be amazed to know there is a simple test that could have been done years earlier for Gale ' simply taking one's blood pressure at the ankle and comparing it with blood pressure taken on the arm. Gale's ankle blood pressure in her right leg was almost non-existent and not much better in her left. A Doppler ultrasound, another simple test, showed the main artery to her right leg was 100% blocked and it was narrowed on the left.
Now Gale was headed for a vascular surgeon. He proposed a major surgery ' that would require 10 days in the hospital ' to open the blood flow. Gale, now being a 'powerful patient on steroids' sought out a second opinion once again. And the information she received changed her life. She saw University of Washington Chief of Vascular Surgery Dr. Ben Starnes, an expert in minimally invasive approaches to unlocking blood vessels. Now Gale felt confident having a procedure. Instead of a long, invasive surgery and more than a week in the hospital, she had a 40 minute endoscopic procedure (with a catheter inserted at her groin) and she went home the same day.
Where before the procedure she couldn't walk for more than 3 minutes without pain followed by numbness, soon she was walking all over her new city, Seattle. She was overjoyed.
There are several lessons here:
- Make sure your doctor listens to your complete medical history. If a doctor had paid attention to the fact that Gale was a smoker and had high blood pressure and high cholesterol, and that the pain was triggered by walking each time after a certain distance, they would have considered a blockage rather than a nerve problem.
- Always ask for a second opinion.
- If you are a senior, do not assume your problem is simply because you are 'getting old' and that you have to live with it.
- If you see a specialist, recognize that they might see diagnoses and approaches only within their specialty. Press them for a 'differential diagnosis,' or what else it could be.
- Once you agree on the medical cause insist on being told, and research yourself, the full range of treatments with an emphasis on what is simplest, least toxic, and, when it comes to surgery, most 'minimally invasive.'
- When you are ready to have a procedure, make sure you have the right doctor to do it. Ask 'how many of these procedures have you performed.' Being patient #1 isn't necessarily a red flag. You just need to go into it with your eyes open.
In a week or so you can hear Gale tell her story with Dr. Starnes putting it in perspective. Soon afterwards we'll be showing you the video Gale is making for us. As you can imagine, it's a walking tour of Seattle!
Wishing you and your family the best of health,