Q: My father is 70 years old. He is a diabetic for last 15 years. Recently he developed a block in a vein near the knee and underwent a bypass for the same. Though some blood flow improved from knee to ankle, but doctors say there is still a block in that area. Doctor say that it could be a clot in very small arteries, so nothing can be done. What are the treatment options for my father to restore the blood flow? Which hospitals in south India have this facility? Which department or specialist should I meet?

A:The blocks in the vessels which occur in diabetics are usually widespread and cause problems in more than one place, so surgery is often not sufficient in restoring blood flow. i) I presume he is on low dose aspirin, and perhaps even clopigrel, to thin his blood. ii) Exercise, to the maximum extent possible, is very helpful in opening up other blood channels, and so improving blood flow. iii) Good control of diabetes is very essential: an HbA1c just above the normal level, frequent blood testing at home at different times to make sure the doses of medicines are adequate. iv) Tight control of blood pressure is very essential: make sure his pressure is as low as he can comfortably manage without symptoms. Ideally, BP should be 110-120/75-80 mm Hg, but somewhat higher levels may need to be accepted if he gets symptoms when he goes to this level. v) I hope his lipid levels are controlled.