Question: Hello Doctor. My question is regarding PVD, PAD. First of all what is the difference between the two? I assume that that one is Vascular & the other being Arterial? I do understand Vascular would be the veins? / Arterial the arteries? If you could explain to me why this disease is so painful. I was diagnosed with PAD - however, is it possible to have PAD and PVD together? Reason why I am asking this question is I have very large "thick" veins on top of both of my feet. I also have noticed that on both legs beneath the knee caps in just a few areas. Sizing in roughly about 1 to 2 inch's in length veins. (but they are thick and stick out very much). I have just been diagnosed this past December following two ultra sounds that I have this disease. Few more questions / concerns I have... I am hoping you do not mind. 1) What causes an individual to receive this disease PAD? I understand smoking CAN be the cause of PAD .. PVD?? I know from reading on the net that PAD indicates smoking as being a possibility in PAD. Yes I have smoked for many years. The past two years now I am smoking only 4-5 cigarettes per day. I have cut down to almost a full stop. (is my goal is to hit 0 cigarettes) The doctor that I have had since 2008 was unfortunately a waste of my time and I can even speak on behalf of all his other patients.(majority are 80% elderlies) However, he only looked at my reports and said, "you have dirty blood". Did not inform me that it was even a disease or that it is actually even considered serious. He down right told me it was MY fault that I have it. (he treats all his patients in this extremely rude, cold, unprofessional. sarcastic & ignorant manner) I am only explaining this to you so that you can understand why I am seeking an answer to this issue. On one side underneath the kneecap to the ankle is all marked up skin. Almost could be taken for skin infection. It is now dark purple in color, almost to a black in color sometimes. Then it is on my top of my foot. Again dark in color, almost looks like a very bad bruise. My left calf is bigger in size than my life calf. My bones have spasms, my bone will pop out so far on my shin .. my toes cramp like, where I have to get up and walk out the bone that feels like a Chairlie Horse. (but it is not a XXXXXXX horse - they are as if they are locked out of place and I have WORK these cramps? XXXXXXX horses?? out. (what do you even call this in medical terms?) My hair seems to be falling out when brushed very much. My Legs and feet retain a great deal of fluid (water) when I sit for a long period of time. However, the pain is incredible and I am not understanding why? I was given no medication for this, nothing what so ever. I could make myself look more like a fool buy going into my questions and unfortunate former M.D. problem but it is not going to do any justice or change the outcome of this disease. So I come to ask you please explain to me the difference in PAD / PVD, if there is a difference even. Why is this so extremely painful. And what do you recommend for medications as I am sure you would agree that medication is necessary. My last two questions is the following, 1) am I the blame for having this illness and secondly I have had multiple operations on both feet for bunion removal. 6 operations on the left foot 3 being fusions and 3 operations on the left foot w/ no fusions. All operations aside form the original were corrections. And I am perfectly healthy aside from this, never did drugs and do not drink what so ever. Reason I tell you this is because you can know that I did not ever abuse myself. Thank you so much for reading this long story.. I am one that gets down to the entire facts. So my concern is why so painful all day and more so at night time, and what can a vascular doctor do for is problem. In case your are wondering, I am only 54 years of age.