12 Aug 2013 01:38

Years ago, when I was a junior hospital doctor, I worked for a vascular surgeon, and one of the most memorable patients was someone we nicknamed Woodbine Willie because he was never without a Woodbine cigarette in his mouth.

He smoked upwards of 80 a day and in those times – can you believe it? – smoking wasn’t prohibited on hospital wards so his ashtray was always piled up with fag ends.

Woodbine Willie loved his habit. He had to. It was responsible for both his legs being amputated below the knee.

Chronic cigarette smoking of the kind Willie indulged in can damage your arteries.

Damaged arteries have a tendency to narrow and fur up, a condition known as peripheral vascular disease, or PVD.

This condition was what cost Willie his legs.

It wasn’t as though Willie hadn’t had warning signs. He’d been feeling pain in his lower legs for quite a while as he walked.

Then it became so bad that he had to stop for a rest until the pain subsided.

Then it woke him at night, and the pain was relieved only by hanging his legs over the side of the bed.

 the time he got into the hands of the vascular surgeon, he found he could walk no more than a few steps.

With the arteries in his legs furred up (and made worse with every ciggie), his muscles couldn’t get enough blood to work.

Deprived of essential oxygen, the muscles throbbed with pain – the same kind of constricting pain as angina.

The faster or further Willie tried to walk, the greater his muscles’ need for oxygen, which his damaged arteries just couldn’t deliver.

The pain Willie suffered is called intermittent claudication.

As the arteries become blocked, the skin of the feet becomes pale, cold and can go blue and numb. It starts to break down as the limb dies.

Ulcers that never heal form – they get bigger and the toes start to turn black.

Despite all this, Willie kept puffing away as one leg, then the second one was removed.

Willie’s PVD was self-inflicted, but it isn’t always.

It can be caused by other conditions, especially those that damage arteries such as high blood pressure, high blood cholesterol and now, in increasing numbers, diabetes.

Any disease of the arteries is worsened by and deteriorates faster because of diabetes.

It used to be Woodbines, now it’s diabetes.