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Subject:	A colleague recommends WH - A Guide to Women's Health: June 2008
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Obesity is a serious problem nowadays—so are the ailments that too much weight can bring, including heart disease, diabetes and more. That's why this issue's feature article on treatments available at John Muir Weight Loss Surgery Center is sure to be of great interest. Be certain, too, to check reports on state-of-the-art remedies for peripheral vascular disease and innovative procedures to relieve hip pain—performed by orthopedic surgeons on staff at John Muir. Look for news you can use about MRSA, the antibiotic-resistant germ, and how to help prevent infection. Flip through the pages to get useful updates on everything from shopping for sunglasses to measuring the intensity of your workouts. They're all timely topics to promote good health. Enjoy!

—J. Kendall Anderson
President and CEO,
John Muir Health

Honors for Our Nurses

John Muir Medical Center - Walnut Creek Campus' nursing program has been honored as one of the nation's best, earning Magnet Recognition Program® status for quality nursing services from the American Nurses Credentialing Center (ANCC). The ANCC recognizes healthcare organizations that demonstrate excellence in nursing practice and adherence to the ANCC's national standards and delivery of nursing services. Nationwide, fewer than 300 healthcare organizations have received this accolade.

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Finding Relief For Leg Pain

What disease starts out as nagging leg pain but could eventually lead to serious infection and amputation— and even boost your risk for heart attack and stroke?

If you're scratching your head, you're not alone. Only about 28 percent of women in the United States know about peripheral vascular disease, which affects about 9 million people across the nation, half of them women. This condition occurs when arteries get clogged with fatty deposits called plaque, reducing blood flow to the extremities, usually the legs.

"The first manifestation of insufficient blood supply is pain when you walk," says Ira Finch, M.D., an interventional radiologist on staff at John Muir Health. "At a later stage, you can develop significant limb ischemia (reduced blood supply)." Because healing requires blood flow, reduced blood supply can lead to wounds and infections that don't heal and possibly the need for amputation.

And there's another reason clogs in leg vessels shouldn't be ignored. "The same problem that's affecting the arteries of the legs can also affect the arteries that go to the heart and brain," explains Keshav Pandurangi, M.D., a vascular surgeon affiliated with John Muir Health. That translates to an increased risk of heart attack and stroke.

Narrowing of the vessels can pop up in one spot, a few spots or along the entire length of an artery. The doctor uses ultrasound and sometimes an arteriogram—an X-ray dye study of the arteries—to diagnose the condition and pinpoint the location of blockages.

Various treatment options can restore blood flow, including minimally invasive techniques. "Endovascular procedures include angioplasty, where a balloon is used to open a vessel, and stenting, where an expanding metal mesh is inserted to hold an artery open," says Dr. Finch. "Some less familiar techniques involve cutting the plaque off the inside of the vessel wall and removing it (atherectomy), and using lasers for burrowing through blocked arteries. There are also techniques that involve breaking up clots using mechanical devices or drugs." The best procedure, he adds, depends on the location and nature of the blockage.

These treatments are continuously being refined, with new advances on the horizon such as drug-eluting stents that decrease the chance of recurrence. John Muir Health continuously strives to adopt leading-edge treatments, Dr. Pandurangi points out. "When new technology is proven effective based on trials and scientific evidence, we make all efforts to adopt that treatment and provide it to patients."

In some cases, such as the blockage of an entire thigh artery, surgical bypass is required. While surgery involves a hospital stay and a bit more discomfort than endovascular techniques, there is an upside— the patient is unlikely to need further treatment of that vessel in the future.

At John Muir Health, patients are also educated about diet, exercise, smoking cessation and other lifestyle changes that can help keep peripheral vascular disease at bay.

Once the condition is treated, the results can be life changing. "We try to get people back to their routine activities of living and take away the pain," Dr. Pandurangi says. "When we do these treatments, they're able to go back to their walks, participate in exercise, and do their shopping or gardening."

Copyright © 2008 by John Muir Health. WH is published three times a year by John Muir Health as a community service and is not intended for the purpose of diagnosing or prescribing. WH Editorial Advisory Board: American Heart Association and the Office on Women's Health, U.S. Public Health Service. Produced by DCP.

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