Peripheral Artery Disease

When Kevin Thomas Morgan was diagnosed with PAD in 2015, he had no intention of letting it stop him from racing—and today, the 80-year-old athlete is still lacing up and competing in triathlons around the world!

A peripheral artery disease (PAD) diagnosis can make you worry that life as you know it is over, but don’t worry—with today’s treatment options, odds are you’ll be able to control your symptoms, stay healthy and enjoy your favorite activities for years to come.

First, you might be wondering what PAD even is. Although your limbs are affected, PAD is actually a type of heart disease. It occurs when cholesterol and/or triglycerides build up inside the arteries that bring blood to your extremities, i.e., your arms, hands, legs and feet. Over time, the body views this buildup as a foreign invader, causing an inflammatory response that caps it with a hard, fibrous material. This process is known as atherosclerosis.
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How will I know if I have it?

In the beginning stages, PAD may have no symptoms. However, some people may experience pain, cramps, weakness, heaviness or numbness in the affected extremity that occurs with activity and goes away with rest.

If you or your doctor suspect you have PAD, they may first order blood tests to determine underlying causes, such as high blood pressure or high cholesterol.

The most common test used to look for PAD itself is called an ankle-brachial index (ABI) test, which compares blood pressure readings from your ankle and arm.

Why it matters

PAD is a serious health issue that can raise your risk for:

Critical limb ischemia. A severe blockage of blood flow to the limb that leads to pain and non-healing ulcers or sores that damage tissue. In some cases, the affected limb may need to be removed.

Heart attack. The blockage of blood flow to the heart, in the case of PAD by a blood clot that broke off from a blockage in your limb. If left untreated, the heart muscle can be damaged.

Stroke. The blockage of blood flow to the brain, in the case of PAD by a blood clot that broke off from a blockage in your limb. If left untreated, stroke can damage brain cells.

Are you at risk for PAD?

It’s not always known what triggers plaque buildup in the limbs, but certain things can make it more likely to occur:

Non-modifiable risks

• Age (postmenopausal for women and over 45 for men)
• Family history

Modifiable risks

• High blood pressure
• High LDL (bad) cholesterol and low HDL (good) cholesterol
• High triglycerides
• Diabetes
• Smoking
• Excess weight
• Inflammation
• Diet high in cholesterol, saturated fat and trans fat
• Lack of physical activity

Neither Kevin nor Judith is allowing peripheral artery disease (PAD) to slow them down. Here, they share their top tips for staying on-the-go—whether battling leg pain, fatigue or whatever PAD wants to throw at them. Ask your healthcare team if their tips can help you, too! —by Amy Capetta

“My best advice? Stay in the race!”
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KEVIN THOMAS MORGAN

Chances are you won’t be able to keep up with Kevin Thomas Morgan. Back in 2009, the veterinary pathologist and scientist from Carrboro, NC, ran in the Boston Marathon at the age of 66, followed by six Ironman races, and today can still be found training for either a marathon or triathlon—at the age of 80-years-young. In fact, he recently flew to Finland to take part in the 2023 World Half Ironman Championships.

“I enjoyed a chilly 1.2-mile open water swim, followed by a 56-mile bike ride and a 13.1-mile run,” he says excitedly.

Yet it may be surprising to learn that this lifelong athlete has been living with PAD for nearly nine years. His health journey began in 2014 when he began experiencing foot pain during his marathon training runs. Since, of course, pain comes with the territory when running 20+ miles, at first he wasn’t too concerned and ran through the discomfort.

“But I knew there was something more going on when my Eagleman Half Ironman Race was ruined by foot numbness and right leg calf pain,” he recalls.

“My muscles were not getting enough blood”

Soon after, Kevin had a routine checkup with the “remarkable vascular surgeon Mark A. Farber, MD, whose team saved my life many times” for a previously diagnosed blood vessel condition. He underwent an ankle-brachial index test (which compares the blood pressure at the ankle with the blood pressure at the arm). And this is when the doctor shared the startling news.  

“He informed me that I’d developed significant PAD, or peripheral arterial disease, in my right popliteal artery,” states Kevin. PAD occurs when blood vessels in the extremities—in most cases, as with Kevin, in the legs—become narrow or blocked, inhibiting their ability to carry blood to and from the heart.

“The severe calf pain I’d been experiencing, called claudication, was due to the muscles not getting enough blood,” continues Kevin. “My doctor also said with a hint of doom that this disease is progressive.”

Although Kevin was a bit dismayed by the diagnosis, it didn’t come as a shock, either. “I’ve known since my early 30s that I have genetically high fat levels in my blood, also known as dyslipidemia. This is a common cause of atherosclerosis.” Atherosclerosis, which is the buildup of fatty plaque in the arteries, also happens to be a top cause of PAD.

“I was the last runner to cross the finish line”

The promising news was that treatment options for PAD have evolved over the years. Non-surgical methods, such as lifestyle changes, exercise routines and prescription meds (including a blood thinner that can help reduce the risk of further complications in adults diagnosed with PAD) have been shown to manage symptoms and improve artery health.

Kevin was advised to start a walking program comprised of three 30-minute walks per week to encourage the growth of collateral circulation (otherwise known as back-up blood vessels) around his blocked arteries.

“I had another marathon scheduled three weeks later, so I remember thinking, I’ll be doing a bit more than three walks a week!” Kevin participated in the marathon as planned—and was the last runner to cross the finish line. “They were closing the course! And this was the moment I realized I had a lot of work to do to fight PAD.”

“I want to help others regain control of their lives”

After dusting himself off from the marathon, Kevin dug into PAD research and developed a plan for thriving in spite of it. To start, he tested various movement modifications he could make during his runs and other activities to improve blood flow to his feet and ease pain—everything from stretching more and avoiding socks that compress the ankles to choosing sneakers with a wider toe box.

“Using Yoga Toes® toe stretchers dramatically delays the onset of muscle pain when I run and has eliminated foot numbness when I walk,” adds Kevin, who also follows a low-fat, vegetarian lifestyle.

Needless to say, he has not stopped moving forward. In 2022, he ran the North Carolina Half Ironman Race and finished first in his age group, which qualified him for the 2023 World Half Ironman Championship in Finland. He also wrote the book How to Fight The Crippling Pain of Peripheral Arterial Disease (available on Amazon) and won the “PAD Warrior Award For Excellence” from The Way To My Heart, the only non-profit providing free education, high-touch advocacy and real-time support for PAD patients.

His number one goal now? To provide hope to fellow PAD friends by helping them to regain control over their lives. “As you can imagine, I’d like to stay on my feet for as long as possible—and I’d like to help you stay on yours. PAD is serious, so we must be equally serious in our work to manage it. Now let’s get started!”

“Don’t forget about self-care!”
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JUDITH LEE TAYLOR

After living with leg pain for a decade and being told it was due to nerve damage from diabetes, Judith Lee Taylor was finally properly diagnosed with PAD in 2020. “By that point, imaging showed that vessels to both legs were 100% blocked, and unfortunately an angioplasty [a procedure where a balloon catheter is inserted into a blood vessel to open the arteries] didn’t work.”

She then underwent a femoral popliteal bypass surgery (which is also referred to as Fem-Pop), but that didn’t help alleviate her PAD symptoms either. At that point, her surgeon wanted to perform a different type of bypass that could result in disfigurement as a last-resort solution.

Luckily, before that happened, Judith wound up connecting with Kym McNicholas, a journalist and founder of TheWayToMyHeart.org, the only non-profit providing free education, advocacy and real-time support specifically for PAD patients.

“She put me in touch with an interventional radiologist who found a different way to access my clogged arteries via my left heel and finally helped alleviate the blockages.”

Today, Judith takes two medicines to manage her PAD, a blood thinner that helps lessen her risk of heart attack, stroke and amputation; as well as a low-dose aspirin. She shares these other tips for taking control of the condition.

Be proactive. Along with finding the right doctor and medication, Judith recommends taking an active role in your health. “Read, ask questions, exercise and reach out to support groups and organizations to learn from others,” she says. “Your doctors are the experts, but you’re the only one who knows your own body—you’re a part of that heart health team and you’re the only one who can truly advocate for you!”

Pay attention to how your body feels. “Check in with yourself after you receive treatment. If something doesn't feel right, find out why—ask your doctors, look up your symptoms—don’t just live with it,” she says. “Do all you can do and use all the tools available to be as healthy as you can be.”

Make time for self-care. “Sleep is not a luxury; it’s essential for keeping your body happy and healthy, so don’t sacrifice it,” Judith states. “Make the time to enjoy music, pray and meditate, too, since those things can alleviate stress, which can negatively impact your cardiovascular health.”

Do a diet check, too. “The food we eat is how we create and rebuild our bodies, so it’s important to fuel it right,” Judith says. The American Heart Association offers numerous dietary suggestions to boost cardiovascular health, such as choosing whole grain foods, consuming an array of colorful fruits and vegetables, limiting sugar and reducing sodium and saturated fat. “Each of us is irreplaceable and deserves compassionate self-care,” adds Judith. “Take time to renew yourself on all levels.”

Have an attitude of gratitude. Judith, a reverend at the Tyler Unity Center in Tyler, TX, practices positive thinking and is a firm believer in the power of giving thanks. “We are stronger, wiser, more intuitive and more loved than we think,” she says. “It has been scientifically proven that our attitude plays a major part in our health responses.” Judith suggests looking for things to be grateful for, such as the people in your life. “And aren't you glad medicine has advanced so much? Gratitude attracts more to be grateful about. Yes, sometimes I hurt so much that I cry, but every day is a celebration—and a chance to make the world a better place.”

MUST I QUIT SMOKING?

Q: Since being diagnosed with heart disease, I started working out more seriously and eating pretty well, but I still can’t kick my smoking habit. I’ve tried quitting multiple times but always gained a lot of weight, which made me more fatigued with less desire to exercise. Will cigarettes really make a difference if I’m practicing other healthy behaviors?

A: Quitting smoking is nearly always the number one thing you can do to reduce your risk of adverse cardiovascular events. Smoking is a very powerful risk factor for heart disease—not only does it promote the development of plaque in your arteries, but it is also associated with the formation of blood clots that trigger heart attacks and strokes. Please ask your doctor for help with smoking cessation—you don’t need to do this alone!—and, if needed, request referral to a smoking cessation specialist. Several strategies are proven to work, including many types of nicotine replacement therapies and other FDA-approved medications.

CARING FOR LEGS AND FEET WITH PAD

Q: I just learned I have peripheral artery disease and have a higher risk of stroke, blood clots and heart attack, so I started walking and making heart-healthy recipes. But I’m concerned about how to best care for my legs and feet. Do you have any recommendations?

A: One of the best ways to protect your legs and feet is to continue to exercise. A safe exercise program (be sure to clear it with your doctor) can improve blood flow to your legs, protect your muscle tone, improve symptoms and reduce the risk of developing wounds and infection. If your peripheral artery disease is severe, you should inspect your legs and feet every day for small breaks in the skin or emerging infections—these should be identified and treated right away!

WILL I NEED A BLOOD THINNER FOR LIFE?

Q: Over a year ago, I recovered from a stroke due to my underlying peripheral artery disease, and my doctor said I need to take a daily blood thinner to prevent another one. I’m improving my lifestyle, so why do I need to take medication every day and will it be for the foreseeable future?

A: Prevention of recurrent heart attacks and strokes (so-called “secondary prevention”) requires a comprehensive approach, and while that always starts with a good diet and regular exercise, that’s not enough. Thankfully, we now have extraordinary medicines that further lower the risk of future heart attacks and strokes. These medications include those that lower cholesterol, treat high blood pressure and manage diabetes. However, preventing blood clots is also key. Currently, a low dose of a blood thinner or a combination of aspirin with another anti-platelet drug are the best options to discuss with your doctor. No matter which regimen you’re on, it’s generally necessary to continue it as long as your risk of cardiovascular disease remains high.

OUR EXPERT:
Michael J. Blaha, MD, MPH,
Professor of Medicine and Director of Clinical Research at Johns Hopkins Ciccarone Center for the Prevention of Heart Disease