A 50-year-old man started experiencing pain in his calf muscles while walking. The pain would be relieved when he paused, but it would recur again after he resumed walking. He has been smoking since his teenage years. Investigations revealed that he was suffering from Buerger’s Disease, also known as thromboangitis obliterans, a chronic and disabling condition that ultimately leads to the loss of one or more limbs. There is inflammation and thrombosis in the medium and small-sized blood vessels of the limbs, primarily affecting the hands and legs, which tends to worsen over time. Although its prevalence in Africa is relatively low, those affected still suffer. This disease develops due to smoking or the use of tobacco in any form. It is said to be more common in men aged 20 to 40 years, but women are not exempt if they have been using tobacco. The reason is not clear, but it is postulated that some component of tobacco is responsible for triggering an autoimmune reaction. This reaction occurs when the body’s immune system attacks its own antigens, leading to an antigen-antibody response. To begin with, the affected individual experiences pain in their calf muscles while walking. When they start walking, there is cramp-like pain in the calf muscles. The pain is severe enough to cause them to stop walking. The pain subsides when they stop walking, but returns when they resume walking. Therefore, an endless cycle begins in which even a simple task like walking becomes challenging. If another limb becomes involved, similar symptoms arise. Pain is experienced when the limb is moved and ceases when the movement stops. As a result of a chronic lack of blood supply, ischemic ulcers develop on the affected limb in later stages. The ulcers worsen the pain. Nerves can be impacted from a lack of blood supply, leading to numbness and abnormal sensations. This makes individuals more susceptible to cuts and other types of injuries. As the disease advances, gangrene (tissue death) in the affected limbs occurs. As the blood supply is reduced, the affected limb turns blue and cold. This is the final stage where the affected part must be amputated. Once the disease begins, it progresses gradually. Quitting smoking can delay or sometimes even halt the progression to gangrene, but any damage that has occurred remains irreversible. However, individuals who have reached this stage are usually highly addicted to tobacco and struggle to quit. Those who continue to smoke, continue to progress rapidly to the stage of gangrene. Buerger’s Disease needs to be distinguished clearly from other conditions that can cause vascular changes in the extremities, such as atherosclerosis (fat deposition in blood vessel linings), Reynaud’s phenomenon, diabetes, and other hypercoagulable states. This distinction is important because these other conditions can potentially be treated with medication, whereas there is currently no effective medical treatment for Buerger’s Disease. The diagnosis is established through Doppler studies, which are a type of sonography that shows the impairment of blood supply in affected areas. Angiograms, which involve the injection of dye followed by X-rays, reveal the locations of occluded blood vessels. Once a diagnosis is confirmed in a patient, the doctor may have no treatment option other than the amputation of the limbs. High potency vasodilators, which are drugs used to open blood vessels, may be attempted, but they are generally ineffective. People who smoke regularly are aware of certain health hazards associated with smoking, such as chronic bronchitis and lung cancer. However, many are unaware of Buerger’s Disease until they personally experience its effects. Prevention lies in avoiding smoking or quitting early. If someone has already started smoking, it is better to stop before becoming addicted and suffering from a chronic, disabling disease. Dr Rachna Pande is a specialist in internal medicine.
