HEALTH: Buerger’s Disease

Buerger’s disease also known as thromboangitis obliterans is a chronic disabling condition, which ultimately leads to loss of one or more limbs. There is inflammation and thrombosis of the medium and small sized blood vessels of the limbs, mostly of hands and legs which tends to progress with time. Statistics show Buerger’s disease to be more common in Israel, Japan and India and a high prevalence exists among south Asians. But one should not presume that it does not exist in Africa or for that matter in Rwanda. In fact, I recently saw a young boy of about 20 years with this problem. He had been smoking for a long time and gangrene had started in both feet. He was sent to the surgeon who had to make the unfortunate decision to amputate his feet. Buerger’s disease develops because of smoking or use of tobacco in any form. It is said to be greater in young men 20 to 40 years old, but women are not exempted either, if they have been using tobacco. The reason is not clear but it is postulated that some constituent of tobacco triggers an autoimmune reaction (reaction against body’s own antigens). To begin with, the affected person experiences pain in the calf muscles while walking. When he/she starts walking, there is cramp-like pain in the calf muscles. The pain is severe enough to make the person stop walking. Pain subsides when the person stops walking. But on resuming, the pain returns. Thus a never ending circle sets in, where one finds something as simple as walking to be difficult. In case of involvement of another limb, same symptoms occur. That is pain occurs on some movement of that limb and stops on cessation of movement. Due to chronic lack of blood supply, ischemic ulcers develop on the affected limb in later stages. They further aggravate the pain. As the disease progresses, gangrene (death of viable tissue) of the affected limbs sets in. The hands or feet become devoid of all sensation, blood supply and become blue and cold. This is the end stage where affected parts have to be amputated. Once the disease starts, it advances progressively. Cessation of smoking can delay or in some cases even stop the progression to gangrene, but damage incurred remains irreversible. But mostly people who reach this stage are hopelessly addicted to tobacco and find it difficult to quit. Those who continue to smoke, continue to progress rapidly to the stage of gangrene. Buerger’s disease has to be differentiated very well from other diseases likely to cause vascular changes in extremities like atherosclerosis (deposition of fat on lining of blood vessels), Reynaud’s phenomenon, diabetes, other hypercoagulable states, e.t.c. Because these other conditions are treatable by medicines, while there is no successful medical treatment for Buerger’s disease. Diagnosis is established by Doppler studies which show the impairment of blood supply in affected parts. Angiograms (X-rays taken after injecting dye) of the involved blood vessels reveal the typical changes of Buerger’s disease. Once diagnosis is confirmed in a patient, the doctor has no treatment option except to amputate the limbs. What a tragic end to pleasures of smoking. Therefore if somebody has started smoking, it is better to give up this habit before getting addicted to it. Otherwise one should be mentally prepared for consequences like Buerger’s disease. The author is a specialist in Internal Medicine.E-mail – rachna212002@yahoo.co.uk