Both foot and hand go cold:
But belly God send thee good ale enough,
Whether it be new or old."
– William Stevenson (c. 153075), British scholar
Gammer Gurton’s Needle
(1575) Act 2 ‘Song’
P
LANNED perdition, I mused as I looked with certain incredulity at Andoy, a 43-year-old amputee. He is back at the Philippine Orthopedic Center consulting again for remaining toes that have turned black and dry. Two years ago, he came for gangrenous toes and left without a leg. I told him to stop smoking or the other leg will go, too. "You haven’t stopped smoking, have you?" He flashed a nicotine smile.
Thromboangiitis Obliterans
. Ambo suffers from Buerger’s disease or thromboangiitis obliterans. This somewhat rare but unmistakable disorders affects 6 out of every 10,000 people. It usually affects men between the ages of 20 and 40. What happens is vasculitis, or inflammation of the lining of small arteries and veins. Clots form, the blood vessels constrict and the end point is the damage of tissues these blood vessels should be supplying. Ergo, gangrene.
The exact cause of Buerger’s disease is not clear. However, smoking is an aggravating factor because of the constricting effects this has on blood vessels.
Signs and symptoms
. The profile of a Buerger patient is completed by the following signs and symptoms.
* Pain in the toes and the rest of the feet, even the ankles and legs
* Fingers and toes turning pale or blue on strong emotions like anger or cold weather (
Raynaud’s phenomenon)
* Pain and tenderness in the fingers, hands up to the forearms
* Skin changes like ulcers and drying
Diagnosis.
Doctors who handle Buerger’s disease with expertise as vascular surgeons (TCVS or thoraco-cardiovascular surgeons), orthopedic surgeons, and rehabilitation medicine specialists. The family medicine practitioner may be the first doctor to suspect Burger’s and a specialist referral is logical. On physical examination, the doctor may find engorged veins on the legs or forearms. The pulses may be absent or diminished. Specific procedures to document blockage of the vessels are a Doppler ultrasound of the extremity and angiography or arteriography. The Doppler will pick up the patency of blood flow sonically. The same is determined by the latter tests by visualizing the flow of radio opaque dye in the blood vessels.
Treatment.
Buerger’s disease has no cure. The next best thing is the control of symptoms like pain brought by reduced blood flow and spasms. The doctor may prescribe pain-killers and vasodilators (help open up blood vessels to increase flow) such as isoxsuprine.
Lighting up is out of the question as tobacco use leads to constriction of blood vessels. Radical pain and control can be achieved by surgical sympathectomy in which nerves that supply an affected area are cut thereby removing involuntary painful spasms. Finally, there is amputation for infection and gangrene.
"Okay Andoy? I’ll see you in the wards," finishing up the admission orders. I wrote "Below Knee Amputation" in the space for "Procedure:" Andoy was resigned to the reality of yet another mutilation. I was resigned to the fact he’ll never stop smoking.
Billboard.
Please get your copy of my book "A Bone, Joint, and Muscle Handbook" – available at National Bookstore and published by Anvil. I’m looking forward to a second printing especially if my dear loyal readers snap up the last few remaining copies. Your charity will go a long way!
Fact/factoid
. Our Sunday Latin. "Vade in pace" (Go in peace). This was the Roman way of saying goodbye.
Dr. Brix Pujalte is an orthopedic surgeon. Contact numbers: 725-3820/727-0001 local 2175/711-6626/711-4276 and 9365717. Write – Cardinal Santos Medical Center, MAB 3 Room 175, Wilson St., Greenhills, San Juan, Metro Manila. E-mail:
jsp@pldtdsl.net. 
