Dr. Keith Roach
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. FP
Dear FP: 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.
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 fromthe 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, whomay 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 is appropriate.
Dear Dr. Roach: Do we know if stomach acids or the bacteria in our intestines kill the COVID-19 virus? D.F.
Dear D.F.: 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.