Mrs Boey (not her real name) was conscious and alert, sitting on her couch in the living room. The 62-year-old did not appear to be in any distress, even though she told the paramedics her foot hurt.

She had woken up an hour ago and shortly thereafter experienced an acute onset of throbbing, constant pain in her right foot that had worsened since. She rated the pain as a five on a scale of zero to 10, and claimed nothing made it better or worse.

While a paramedic spoke with her about her medical history, another inspected her foot. He noted her right foot was pale, with a delayed capillary refill – a test used to assess blood flow through tissues – and cool to the touch compared with her left foot.

He also noted that the pedal pulse – an arterial pulse that can be felt on top of the foot in front of the ankle – on the right side was present but barely palpable, while the pulse on the left side was strong. Mrs Boey could still move her toes and feel him lightly touching them.

She told them she had a history of insulin-dependent diabetes, high blood pressure, an irregular heartbeat, and coronary artery disease, with a stent placement two years ago.

She had also had a stent placed in her leg about a month ago. The doctor put a catheter in her groin and a balloon in the artery in her leg – a procedure known as a balloon angioplasty.

Meanwhile, the other paramedic inspected her medications, which included insulin and Plavix, an antiplatelet medication used to prevent the formation of blood clots.

Noting that the Plavix was a sample dose and the bottle was now empty, he asked if she had been taking it regularly. Mrs Boey admitted she had run out three weeks ago.

The paramedics called and requested that a doctor be on standby to attend to her. They administered oxygen and explained to Mrs Boey that they were concerned she may have a blood clot in her leg, and wanted to bring her to the hospital as quickly as possible.

Her family started to gather her belongings while the paramedics placed her on the stretcher and prepared her for transport. A hospital 30 minutes away had the resources and a resident vascular surgeon to best handle their patient.

After a thorough examination by the vascular surgeon, Mrs Boey was diagnosed with critical limb ischemia, a severe blockage in the arteries of the lower extremities that markedly reduces blood flow. She successfully underwent an endarterectomy, which is the removal or excision of plaque from the artery.

The success rate of this procedure is usually around 90-95%, although it depends on the extent and cause of the artery blockage. The doctor advised Mrs Boey to modify her lifestyle to reduce the risk of recurrence, including by:

• quitting smoking;
• increasing physical activity or doing gentle exercises regularly;
• eating healthy with less fat and cholesterol;
• keeping better control of pre-existing conditions such as diabetes, cholesterol and hypertension;
• using blood-thinning medications or anticoagulants as prescribed; and
• visiting the vascular surgeon regularly to examine her leg.

TELEME Healing Life Stories is a collection of inspirational stories of how ordinary people triumph over their health conditions and recover to lead a healthier life. Email [email protected] to share your story.

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