Arterial-brachial index measures artery blockage
BY KEITH ROACH, M.D.
DEAR DR. ROACH: I’m an 88-year-old woman in good health except that I have had a lot of leg and back pain in the past two or so years. I had spinal stenosis, and I have arthritis as well. A vascular surgeon performed a lower extremity duplex Doppler test last month. It showed an ankle-brachial index of 0.76 on the right and 0.57 on the left. The surgeon said nothing has changed since the last test and that I should see him again in a year. I need help because I’m in pain, and there is no medication that helps. I stay fairly active and take care of my 93-year-old husband who suffers from dementia, as well as doing all the cooking, shopping and cleaning. — FP
ANSWER: The arterial-brachial index is a measure of blockages in the arteries. Levels between 0.4 and 0.9 often come with symptoms. The symptoms of blocked arteries are pain with exercise, often in the calf muscles, which go away within a minute or so of stopping exercise. This is due to the muscles not getting enough oxygen-rich blood to support activity. As the arterial-brachial index gets lower, below 0.4, leg pain may occur even at rest, and people are at risk for nonhealing ulcers.
Arthritis and spinal stenosis may cause leg pain as well, but the characteristics of the pain are usually different enough that a careful history can sort out which is the likely cause of the pain. Sometimes it is hard to determine, and further testing is needed. If the pain is thought to be from the blockages, then a stent or similar procedure to open the arteries would be considered.
A vascular surgeon is an expert in management of blockages in arteries, and it sounds like he doesn’t think your symptoms are due to blockages. I would recommend you confirm that with the surgeon, and if that’s true, then you should discuss your arthritis symptoms and spinal stenosis with your regular family doctor, who may wish to get further testing or refer you to an expert, such as a rheumatologist for arthritis, or a neurologist for spinal stenosis.
I understand you have tried medications. Making as sure as possible of the cause of the pain is important, as it will help decide whether medication or other intervention (with caution due to your being 88) is appropriate.
DEAR DR. ROACH: Do we know if stomach acids or the bacteria in our intestines kill the COVID-19 virus? I am worried when I don’t see people wearing gloves. — D.F.
ANSWER: The vast majority of cases of COVID-19 come from inhaling infectious particles from a person with the virus, whether that person is symptomatic or not. The virus is inhaled into the lungs, where the infection progresses. Stomach acid and your intestinal bacteria are not effective at preventing infection since the infection starts directly from inhaled particles.
In theory, it is possible to become infected with SARS-CoV-2, the virus that causes COVID-19, through the oral route, perhaps by touching an infected surface and then touching your mouth. However, this seems to be a rare way of acquiring the infection. Of course, gloves and careful hand hygiene are absolutely appropriate when taking care of a person with known COVID-19 infection.