Buerger’s Disease

BUERGER’S DISEASE

(Thromboangitis Obilterans)

Buergers’s Disease is an inflammation of the arteries, veins and nerves in the legs primarily leading to restricted blood flow.  Left untreated, Buergers’s disease can lead to gangrene to affected areas.  Buergers’s disease is also know as “Thromboangitis Obilterans”

WHAT CAUSES IT?

Buerger’s disease is also known as thromboangitis obilterans and it’s precise cause is unknown.

It is estimated that Buerger’s disease affects 6 in every 10,000.  It is most often seen in young to middle aged men (20-40), and who are heavy smokers of cigarettes.  It can run in families and is most common in Asians and Eastern Europeans.

Cases of this disease in non-smokers is very rare, hence cigarette smoking is considered a caustic factor.

The disease is mainly seen in the legs of affected persons, but may occasionally be seen in their arms.

WHAT ARE THE SYMPTOMS?

Symptoms of this disease occur as a result of inadequate blood supply to the tissues, and include tenderness or pain in the feet or hands during exercise, or when at rest.

Other possible symptoms including tingling and or numbness in the limbs similar that that found in Raynard’s Disease. In this case the hands turn colour—white, blue then red—when exposed to the cold.

Eventual damage and destruction of the tissues can occur and this may lead to ulcers in the skin and gangrene of the limbs.

DIAGNOSIS

Diagnosis is usually made from clinical symptoms.  People frequently complain of numbness, tingly, or burning sensations in affected areas before evidence of vascular inflammation becomes apparent.

KEY TERMS

Inflammation

A local reaction to irritation, injury, or infection shown as pain, swelling, redness and occasional loss of function

Ischemia

A decrease in the blood supply to an area of the body caused by obstruction or constriction of blood vessels.

Phlebitis

Inflammation of a vein

Gangrene

A decay of the tissues in a part of the body that experiences restricted blood flow.

TREATMENT

There is no effective medication or treatment for this diseases.

Medical evidence suggests that by stopping smoking can halt further symptoms.

Vasodilators, drugs that increase the diameter of the blood vessels, can be administered, but may not be effective.

Exposure of the affected limbs to heat or cold should be avoided.

Trauma to the feet and other affected areas should be avoided and infections should be treated promptly.

PREVENTION

Not smoking reduces the risks of developing the symptoms of Buerger’s disease.  Avoiding the cold will reduce the risk of symptoms developing in those who already have the disease.

There is no cure for Buerger’s disease.  The only effective treatment is to STOP SMOKING.!

If an affected person continues to smoke they are very likely to need an amputation of toes and/or fingers or in extreme cases limbs.  Infections should therefore be treated promptly.

“SELF HELP” MEASURES

  • If you smoke STOP.  This is the single most effective treatment.  If you find this difficult to do then speak to your GP who would be able to refer you to an organisation such as ASH.

By stopping smoking you can increase your walking distance by two or threefold in over 8 out of 10 people. (stopping smoking also greatly reduces your risk of a heart attack or stroke).

  • Exercise regularly.

Exercise encourages other smaller arteries in the legs to increase circulation and improve the blood supply.  It will improve your symptoms and the distance you will be able to walk before you experience pain.  Walking, swimming or cycling are also good for the heart.

Research studies show that—if you stop smoking, and exercise regularly, then your symptoms are unlikely to worsen, and they often improve greatly.

  • Lose weight

Losing weight reduces the demands on the heart and leg muscles.

 

 

  • Eat a healthy diet

 

1. At least 5 portions of fruit and veg every day

2. The bulk of most meals should be starch based—       cereals, whole grains, rice, pasta, bread and potatoes

3. Not too many fatty foods

4. Include 2-3 portions of fish—1 should be an oily fish     such as salmon or tuna.

5. Eat lean meat and poultry

6. Include good oils—such as sunflower, olive and rapeseed

7. Use less salt and avoid over salty foods

  • Take care of your feet

1. Try not to injure your feet—it may lead to an ulcer or infection developing more easily if the blood supply to the feet is reduced

2. Do not wear tight socks or shoes

3. Trim your toenails “straight” across ( rather than “round”)

4. Tell you doctor if you have any foot pain, when you are resting, or any marked change in skin colour or temperature of your feet.

AMUPTATION

Leg amputations are most commonly performed at one of two sites—just above or just below the knee.  These sites are chosen for their suitability for fitting an artificial leg once the wound has healed.  Where possible, the knee joint is preserved by performing a below the knee amputation.

Amputation, however is always the last resort and will only be recommended if it does not look possible to improve the circulation to the limbs any other way.

Recovery from amputation, and learning to walk again with an artificial leg can take several weeks or even months.

In straight forward cases, an amputation should heal within 2 weeks.  As with any surgery there will be a certain amount of pain.

However, a unique feature following amputation is a common complaint called “phantom pain”.  It can be distressing to “feel” pain in a limb that isn’t actually there.

Once the wound has healed, measurements will be taken for an artificial limb and physiotherapists will be involved in your care.

It can be quite difficult to get used to an artificial limb, and occasionally a person may not be suitable to even attempt it.  It is essential that you have a FIRM RESOLVE to walk again, because it can be very hard work.

This can be made easier by help from skilled physiotherapists and nursing staff who are used to caring for amputation patients.

PHANTOM PAIN MANAGEMENT

Phantom sensation is usually experienced by most amputees at one time or another.  It can range from a mild tingling pain similar to “pins and needles” on an occasional basis, to severe sharp pain on a daily basis, that can really only be controlled via professional pain management.

Phantom pain is not just the feeling of having a limb when no limb is present (which usually goes away).  It is a term used for any sensation or pain originating from the residual limb (stump).

It can help to try the following methods to gain relief from the sensation of phantom pain—These methods don’t always work, and what works for one may not work for another.

1. Wrap your stump in a warm, soft fabric—such as a towel. The warmth will sometimes increase the circulation.  Poor circulation is thought to contribute to phantom pain.

2. Mentally exercise the limb that isn’t there in the area that is painful.  For example if you are experiencing painful sensations in toes that have been amputated—try stretching or walking around to exercise that limb.

3. Mentally relax the limb that isn’t there.  For example if you are experiencing pain in the fingers of an amputated hand then try to flex and stretch the fingers of that hand as if they were therr.

4. Exercise the stump.  Rotate and flex the joint closest to the stump, so to increase the circulation to the affected area.

5. Put an ace wrap or shrinker sock on.  If you have a prosthesis—put it on and take a short walk.

6. If you have a prosthesis on, take it  and the sock off and but it back on  after a few minutes.  Sometimes, the stump is being pinched and changing the way it is on will relieve the pressure on that nerve.

7. Soak in a warm bath or use a shower massager or whrirlpool jet on your stump.

8. Massage your stump with your hands, or better still get someone else to do it so that you can try and relax your whole body.

9. Keep diary of when the pain is most severe. This can help you and your doctor identify reoccurring causes.

10. Wrap your stump with a heat pad.

FARABLOC FABRIC SOCKS

Farabloc evolved from primary research on phantom limb pain (also known as phantom limb syndrome) as a result of amputation. Now distinguished researchers in Europe and North America have demonstrated the effectiveness of this revolutionary product to ease back pain and sports injury related muscle pain.   Farabloc fabric looks and feels like a piece of linen, but contains extremely thin steel fibres.  At the first hint of phantom pain it can be wrapped around the stump, for pain relief.

Farabloc is an easy to use, drug free alternative to the side effects painkillers.

People who experience the symptoms of Buerger’s disease and have to learn how to live life with a amputated limb, learn to be stronger people—You need a firm resolve to be able to live life to the full—and it can be done.

The world can still be your oyster and it is only you who can prevent you doing things that  you want to do.  Just try!

Some people find relief through self-hypnosis and home remedies.

If you find that the pain is not being controlled through these methods or through your normal medication, then speak to your doctor about specific pain control techniques that you could try.