Stop Smoking, Start Fighting Artery Disease

Healthy lifestyle slows progression of symptoms.

Jim Scully was only six when his parents, both former smokers, warned him and his siblings about the health risks of getting hooked
on cigarettes.

Photo by Jordan Pysz.

Jim is enjoying a healthier, more active lifestyle.

But that didn’t prevent Jim from picking up the habit when he enlisted in the Army at 18, just out of high school. He sampled a cigarette at a party, and though he didn’t like it at first, Jim soon found himself with a half-pack-a-day habit.
The frequency of his smoking varied over the years, topping out at two packs a day. Jim, a retired Army first sergeant who now lives in Riverview, especially craved cigarettes when he didn’t have work, another activity or someone’s company to distract him.
“My family lives in Foley, Alabama. That’s an eight-hour ride from here,” Jim notes. “If I went to visit and my wife was with me, I didn’t smoke in the car. If I went by myself, I’d go through a pack and a half.”
About eight years ago, just before Christmas, Jim began experiencing a burning sensation in his left calf, numbness below his knee and difficulty walking.
“I knew I hadn’t hurt it in any way that I could remember, like bumping it or falling, but I knew something was wrong,” Jim remembers. “What was wrong, I wasn’t quite certain.”
At the time, Jim worked for a communications electronics repair company and supervised employees in neighboring buildings, one of them about 400 yards from his office.
“To walk there and come back would flat wear me out,” Jim complains. “I was almost dragging my leg.”
He also became fatigued more quickly than usual while enjoying his favorite pastimes: boating, fishing and yard work.
“I was having a tremendously difficult time pushing my lawn mower, to the point that I went and bought a riding mower,” Jim shares.
Though his condition worsened, Jim planned to wait until after the holidays to see a doctor. His son, an emergency medical technician, had other ideas.
“He happened to come by my house and asked me what was going on,” Jim relates. “I told him, and he said I needed to go to the hospital immediately; that I had either a blockage or a blood clot.”

Smoking Has Consequences

An ultrasound revealed that the artery extending from Jim’s groin to his knee had a 95 percent blockage as a result of peripheral vascular disease, also known as peripheral artery disease (PAD). It’s a progressive circulatory disorder caused by genetics and unhealthy lifestyles. Deposits of fat and calcium narrow the arteries and reduce the blood supply to the limbs. Left untreated, the disease can result in gangrene and amputation.
PAD patients are additionally at risk of clogged arteries that send blood to the heart and brain. Their chances of a heart attack and stroke increase as well.
Jim insisted on finding his own vascular surgeon to treat him, rather than have the hospital assign one. After a fortunate coincidence, he chose
Vijay B. Narasimha, MD, of Surgical Associates of Tampa Bay in Brandon.
“I looked in my wallet and happened to have his business card,” Jim recalls. “A surgical nurse I know told me he’s an exceptional surgeon and that she would recommend him. When I called his office, they told me he’d done an emergency appendectomy on me a couple years prior. They made an appointment for me to see him the first day that he returned after the holidays.”
After a thorough evaluation, Dr. Narasimha recommended starting Jim on a conservative course of treatment.
“What we mean by that is lifestyle changes,” the vascular surgeon explains. “We tell patients not to smoke, and we put them on aspirin to thin their blood. We also put them on other medications to improve their circulation, and we encourage walking, exercise and eating healthy– avoiding a high-fat diet.”
Though Jim did smoke less, he didn’t give it up completely. Because conservative efforts to slow his disease didn’t yield much improvement, Dr. Narasimha next recommended a nonsurgical procedure called an angioplasty. A thin tube (catheter) with a deflated balloon on its tip is passed into the affected part of the artery, then the balloon is inflated to clear the blockage.
Dr. Narasimha also placed stents in Jim’s artery. The wire mesh tubes expand and lock open to allow his blood to flow freely.
“Then his blockage recurred, and we had to go back in again,” says
Dr. Narasimha, who has performed six angioplasty procedures on Jim over the past six years. No treatment for PAD lasts forever because of the nature of the disorder, the surgeon cautions.
“Once people have peripheral vascular disease, they’re at risk all throughout their lives for the progression of the disease,” he emphasizes. “Even lifestyle changes do not reverse the disease process. They just delay the progression.”
Another option to treat arterial blockages is an atherectomy, during which
Dr. Narasimha uses a catheter with a sharp blade on the end to remove plaque from a blood vessel. He inserts the catheter through a small perforation in the artery while his patient is under local anesthesia.
“Sometimes when the whole artery is blocked, we can do what we call a remote endarterectomy, where we open the artery and then pour out plaque along the entire length of the artery and put in a stent,” Dr. Narasimha informs.
As he continues to periodically monitor Jim and tend to his blockages, the surgeon has given Jim a blunt assessment of what will happen if he continues to smoke: He’ll lose his leg.
Dr. Narasimha “doesn’t beat around the bush,” Jim observes. “He tells you what you need to do and what the consequences are if you don’t.”
But Jim tried time and again to quit cold turkey, only to resume his hard-to-kick habit after two to three months of abstinence.

Finally, Stop-Smoking Success

An ultrasound in early January revealed Jim’s artery is beginning to clog again, although Jim says it hasn’t progressed to the point of requiring another procedure. He’s scheduled for a follow-up with Dr. Narasimha in July, unless he needs to come in sooner.
Jim is looking forward to his next appointment and the opportunity to tell Dr. Narasimha that he’s finally managed to give up cigarettes – for good.
“On the first of this year, I made a decision that I would stop,” Jim asserts, “and I haven’t smoked at all this year.”
While he’s essentially gone cold turkey again, Jim did seek help from the state’s Tobacco Free Florida program, which sent him informational materials and supportive daily texts. They also called him occasionally to track his progress and provided nicotine patches that he tossed aside after only one trial.
By late January, Jim told the state anti-smoking advocates he no longer needed the texts and phone calls.
“I am a former smoker,” he declares. “I know this time it’s for real.”
Jim also has a “good man” looking out for his health.
“I’ve already told people they need to see Dr. Narasimha,” Jim enthuses. “My experiences with him have always been good.”

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