By Tedler D. Depaynos, MD
It was quite some time when the impression of Buerger’s Disease was given. Nowadays it is usually the specialists who give the diagnosis after extensive work-ups. A news item claiming that the President is suffering from this disease secondary to his extensive smoking stimulated a lot of inquiries. Most of them were of course directed to the only medical personnel around verifying if it is also related to his alleged womanizing and intake of some pills that made him able to maintain several households. Because of his limited experience the medical personnel just continued drinking his coffee as he parried most of the questions unanswered trying of course to cover up his ignorance. Most of his expert coffee mates obviously were not fooled.
The medical personnel could recall that he was just a medical student when a Chinese medical practitioner whom he admired so much first gave the impression of Buerger’s disease to a patient who was confined in his hospital. He could remember that the patient was complaining of leg pains whenever he ran or walked fast which was relieved by rest and that the digital pulse of the affected leg was weaker compared to the other. In our old textbooks, the pain stimulated by exercise was called claudication and the weak pulse implies poor oxygen supply causing the affected extremity to appear pale. Actually, this was supposed to be the pathology of this disease. There was obstruction of the arteries supplying the extremities and the upper extremities could also be involved. In extreme cases non-healing wounds may occur or simply gangrene because of poor tissue oxygenation.
Cases encountered nowadays mostly involve the lower extremities, sometimes bilateral and the narrowing of the blood supply is usually due to “atherosclerosis”. The chemical mechanism is complicated but in layman’s terms this is simply due to the accumulation of undesirable “lipids” in the walls of the arteries which may cause their narrowing. Of course it could affect all the other blood vessels of the body especially the coronary arteries supplying the heart muscles causing “ischemia” or chest pains.
The affected arteries of the extremity may somehow get inflamed and may dislodge the attached “lipids” or “atheroma” forming a “thrombus” causing obstruction, hence, the term “Thromboangitis Obliterans”. This is now a more common diagnostic term given by non-specialists.
Two or three decades ago, there were no sophisticated diagnostic instruments then so that diagnosis was mainly by clinical acumen. Nowadays a simple non-invasive Doppler Ultrasound is used to visualize the arteries and not only obstruction could be localized but the amount of blood flow could be determined. Hence the diagnosis could be very precise.
Smoking is an accepted etiology because it may cause arterial constriction but many medical practitioners nowadays tend to consider it as a complication of uncontrolled Diabetis Mellitus. Diabetis is a very insidious disease that in the early stage, the patient in general does not feel anything. It is only when complications occur which may happen after 5 to 10 years of being diabetic that the patient may manifest signs and symptoms and because they arise from the complications, they are usually irreversible and one of them is arterial obstruction. With persistent pain or non-healing wounds in the affected limb which may be worsening, some patients opt for amputation.
It would be hard to imagine a president with only one or no legs. **
