From Baptist Health South Florida
5 min. read
Written By: Peter B. Laird
Published: October 5, 2022
Written By: Peter B. Laird
Published: October 5, 2022
In all of the jobs she has held over the years, working eight to 12-hour days was routine, according to Mrs. Hilton, who was a bartender in her younger days, followed by years of working as a waitress. Later, after she says she had “aged out” of those professions, she took a job as a deli worker at the Dadeland Miami Publix. That location, she says, has the busiest deli and highest sales volume of any of the chain’s 1,288 stores across the southeast U.S. She was on her feet all day when at work, and it began to take a toll on her physical health.
Mrs. Hilton, who lives alone in south Miami-Dade County, says her health was “a mess” and that she smoked for most of her adult life until quitting 18 years ago. About 10 years ago, she started noticing pain in her legs and hip when she would walk the short distance to and from her car at work. “It was horrible pain – every step was excruciating and would bring me to tears,” she recalls. “It still makes me cry even now, just thinking about it.”
Mrs. Hilton was reluctant to seek medical care because she had no health insurance at the time and was worried about having to take time off from work. “I was living by myself and paying off my house and my car. I couldn’t afford health insurance and I couldn’t afford not to work,” she explains.
With her pain continuing to grow worse, Mrs. Hilton made the difficult decision to apply for social security and retire on disability. The pain was so bad, she was bedridden for months and had to rely on her longtime friend and neighbor, Vivian Barrios, to deliver her groceries, cook meals and drive her to doctor appointments. Mrs. Hilton even had to give up her passion for creating art and the additional income that came from selling her work online. “I couldn’t sit in a chair to paint anymore,” she says.
Eventually, in one of her first visits to a doctor after retiring, x-rays revealed one of the reasons for her debilitating pain: Mrs. Hilton’s hip bone was essentially gone. Arthritis had eroded the entire ball of her left hip “down to a stick,” she says, and she had to undergo a hip replacement in June 2021.
After a month in the hospital followed by a month of in-home physical therapy, Mrs. Hilton’s new hip was feeling better but she still had sharp pain in both of her legs. “I had to get a walker that I could sit on because I could only walk a step or two at a time, the pain was so bad,” she says. “I knew I wasn’t getting blood circulation because I couldn’t breathe and I couldn’t walk.”
After seeing more doctors and undergoing “a battery of tests,” Mrs. Hilton was referred to Constantino Pena, M.D., a diagnostic and vascular interventional radiologist at Miami Cardiac & Vascular Institute. Dr. Pena examined her and quickly determined that she had a common condition called Peripheral Arterial Disease (PAD) that was causing her severe leg pain.
PAD is a slow and progressive disorder in which the blood vessels – particularly in the legs – become narrow or blocked due to atherosclerosis, or the build-up of cholesterol plaques, preventing extremities from getting enough blood, Dr. Pena says. “If the pain occurs while walking but goes away with rest, that’s what we call claudication, a common form of PAD.”
According to the U.S. Centers for Disease Control and Prevention (CDC), PAD affects more than 6.5 million U.S. adults over the age of 40. Dr. Pena suspects the actual number is much higher, because roughly half of the people diagnosed with PAD have no obvious symptoms and many cases likely go undiagnosed. “There are probably more than 10 million Americans with PAD,” says Dr. Pena, adding that PAD is now considered a leading indicator for coronary artery disease, heart attack and stroke.
PAD is usually associated with other underlying health issues that also need to be addressed, Dr. Pena notes. Most patients can be treated with anticoagulants and monitored over time, Others, like Mrs. Hilton, have extreme cases that have been developing for years and years. “Those are the ones who require more aggressive treatment, which may include surgery to remove the clot or placing a tiny stent inside the vein to prop it open, allowing blood to flow unimpeded,” he explains.
For Mrs. Hilton, Dr. Pena recommended the minimally invasive stenting procedure, which she underwent earlier this year. Stents were placed inside veins in her legs and in her chest. The first try was unsuccessful, he says, because the vessels in her legs were so narrow and the vessel walls were no longer supple but had become calcified like bone. “Even though she quit 18 years ago, years of heavy smoking have taken their toll on her arteries,” Dr. Pena says. He took a slightly different approach and was able to successfully implant the four stents in Mrs. Hilton’s chest and legs.
The results were rapid and dramatic, reports Mrs. Hilton. “The very next day, I was walking fine and I had no pain anywhere – I couldn’t believe it,” she exclaims, adding that she is grateful Dr. Pena was able to immediately see what other doctors had missed, and help restore her quality of life.
Dr. Pena says Mrs. Hilton suffered from a particularly severe form of PAD known as critical limb ischemia (CLI), a severe blockage in the arteries of the lower extremities that markedly reduces blood-flow. If left untreated, CLI can lead to amputation of the limb, he says. “There is a big push to identify and treat PAD before surgical intervention is required, because data shows that amputation greatly increases the patient’s chance of dying.”
As for Mrs. Hilton, whom Dr. Pena calls “a great patient,” he says she was fortunate her PAD didn’t progress any further to the point amputation would be required. “She’s doing great now, and she has an excellent prognosis,” he says. “Mrs. Hilton’s case is why we do what we do. It’s pretty special when you can help make such a rapid and dramatic improvement in someone’s quality of life.”
Mrs. Hilton says she’s amazed how one thing can change a person’s life so profoundly and she is extremely pleased with her experience at Miami Cardiac & Vascular Institute. “Baptist Health is the best. I have a quality of life again that I thought I had lost forever,” she says. “I want to go back to work now!”
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