Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Dr. Kulick received his undergraduate and medical degrees from the University of Southern California, School of Medicine. He performed his residency in internal medicine at the Harbor-University of California Los Angeles Medical Center and a fellowship in the section of cardiology at the Los Angeles County-University of Southern California Medical Center. He is board certified in Internal Medicine and Cardiology.
There are two ways atherosclerosis causes disease; 1)
atherosclerosis can limit the ability of the narrowed arteries to increase
delivery of blood and oxygen to tissues during periods of increased oxygen
demand such as during exertion, or 2) complete obstruction of an artery by a
thrombus or embolus
(thrombus and embolus are forms of blood clots; see below) resulting in tissue
necrosis (death of
tissue). Exertional angina and intermittent claudication are
two examples of insufficient delivery of blood and oxygen to meet tissue demand;
whereas strokes and heart attacks are examples of death of tissue caused by
complete artery obstruction by blood clots.
There are many similarities between coronary artery
diseases (atherosclerosis involving the arteries of the heart) and peripheral
artery disease. For example, patients with exertional angina typically have no
symptoms at rest. But during
exertion the critically narrowed coronary arteries are incapable of increasing
blood and oxygen delivery to meet the increased oxygen needs of the heart
muscles. Lack of blood and oxygen causes
chest pain (exertional
angina). Exertional angina typically subsides when the patient rests. In
patients with intermittent claudication, the narrowed arteries in the lower
extremities (for example, a narrowed artery at the groin) cannot increase blood
and oxygen delivery to the calf muscles during walking. These patients experience pain in
the calf muscles that will only subside after resting.
Patients with unstable angina have critically narrowed
coronary arteries that cannot deliver enough blood and oxygen to the heart
muscle even at rest. These patients have chest pain at rest and are at imminent
risk of developing heart attacks. Patients with severe artery occlusion in the
legs can develop rest pain (usually in the feet). Rest pain represents such
severe occlusion that there is insufficient blood supply to the feet even at
rest. They are at risk of developing foot ulcers and gangrene.
When the arteries are narrowed as a result of
atherosclerosis, blood tends to clot in the narrowed areas, forming a so-called
thrombus (plural thrombi). Sometimes pieces of the thrombi break off and travel
in the bloodstream until they are trapped in a narrower point in the artery
beyond which they cannot pass. A thrombus or piece of thrombus that travels to
another point is called an embolus (pleural emboli). Thrombi and emboli can cause
sudden and complete artery blockage, leading to tissue necrosis (death of
tissue).
For example, complete blockage of a coronary artery by a thrombus
causes heart attack, while complete blockage of a carotid or cerebral artery
causes ischemic stroke. Emboli originating form atherosclerosis in the aorta
(the main artery delivering blood
to the body) can obstruct small arteries in the feet, resulting in painful and
blue (cyanotic) toes, foot ulcers, and even gangrene.
What are collaterals?
Sometimes, despite the presence of a severe blockage in
an artery, the involved area does not become painful or ischemic due to the
presence of collateral circulation, meaning that the particular area is supplied
by more than one artery to an extent that blockage of a single vessel does not result in
a severe degree of ischemia. Collateral circulation can develop over time to
help provide oxygenated blood to an area where an artery is narrowed. Doctors
believe that regular supervised exercise can stimulate the growth and development of collateral circulation
and relieve symptoms of intermittent claudication.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Muscle cramps are involuntarily and forcibly contracted muscles that do not relax. Extremely common, any muscles that have voluntary control, including some organs, are subject to cramp. Since there is such variety in the types of muscle cramps that can occur, many causes and preventative medications are known. Stretching is the most common way to stop or prevent most muscle cramps.
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Cholesterol is naturally produced by the body, and is a building block for cell membranes and hormones. Low-density lipoprotein (LDL) cholesterol is the "bad" cholesterol, conversely, high-density lipoprotein (HDL) cholesterol is the "good" cholesterol. High cholesterol treatment includes lifestyle changes (diet and exercise), and medications such as statins, bile acid resins, and fibric acid derivatives.
Corns and calluses are sometimes painful areas of thickened skin that appear between the toes and fingers or on the soles of the feet. Abnormal foot anatomy, ill-fitting footwear, and unusual gait can put increased pressure in specific areas, causing corns and calluses. Treatment may involve using over-the-counter salicylic-acid products, visiting a podiatrist to be fitted with an orthotic device, or surgical removal.
Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.
Heart disease (coronary artery disease) is caused by a buildup of cholesterol deposits in the coronary arteries. Risk factors for heart disease include smoking, high blood pressure, heredity, diabetes, peripheral artery disease, and obesity. Symptoms include chest pain and shortness of breath. There are a variety of tests used to diagnose coronary artery disease. Treatment includes life-style changes, medications, procedures, or surgery.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Intermittent claudication, or pain and cramping in the lower leg is caused by inadequate blood flow to the leg muscles. This lack of blood flow causes a decrease in oxygen delivered to the muscles of the legs. Claudication is generally felt when walking and decreases with rest. In severe cases, claudication may be felt at rest. Narrowing of arteries cause claudication. Treatment includes exercise, medication, and in some cases surgery.
Aseptic necrosis (avascular necrosis or osteonecrosis) is a condition that develops when blood supply diminishes to an area of bone and causes bone death. Though aseptic necrosis may be painless, pain is often associated when the degenerating bone is used. If caught early, aseptic necrosis may be treated by grafting new bone into the degenerating area. In later stages, joint replacement surgery may be required.
Cholesterol is the most common type of steroid in the body. The treatment of elevated cholesterol involves not only diet but also weight loss, regular exercise, and medications. By understanding your cholesterol profile you can better manage your cholesterol levels.
Lymphedema is a condition in which one or more extremities become swollen as the result of an impaired flow of the lymphatic system. There are two types of lymphedema; primary, secondary. Filariasis is the most common cause of lymphedema worldwide; however, in the U.S. breast cancer surgery is the most common cause. Symptoms include swelling of one or more limbs, thickening, cracked, and secondary bacterial or fungal infections of the skin. There is no cure for lymphedema.
Diabetes-related foot problems can affect your health with two problems: diabetic neuropathy, where diabetes affects the nerves, and peripheral vascular disease, where diabetes affects the flow of blood. Common foot problems for people with diabetes include athlete's foot, fungal infection of nails, calluses, corns, blisters, bunions, dry skin, foot ulcers, hammertoes, ingrown toenails, and plantar warts.
Vitamins and exercise can lower your risk for heart attack and heart disease. Folic acid, vitamins, and homocysteine levels are interconnected and affect your risk for heart disease or heart attack. Antioxidants and exercise also play a key role in heart attack and heart disease prevention. Lower your risk factors for heart disease and heart attack by lowering cholesterol, lowering blood pressure, diabetes prevention, and smoking cesssation.
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